Conversion surgery for gastric cancer is defined as surgery for tumors with distant metastases that are technically or oncologically unresectable at diagnosis, with the aim of achieving R0 resection after chemotherapy. However, there is no randomized controlled trial evidence comparing conversion surgery with continued chemotherapy at the stage of response to chemotherapy. In addition, there are no recommendations on appropriate targets, timing of surgery, extent of resection, pre-and post-operative chemotherapy regimens or duration of chemotherapy, which are issues that need to be resolved. A randomized controlled phase Ⅲ trial is currently underway to address these clinical questions, and it is hoped that this will provide some answers to the long debated significance of conversion surgery.