Abstract:As a major global public health concern, the standardized management of gastric cancer has been increasingly systematized in several countries and regions, resulting in the development of distinct clinical guidelines. This review provides a systematic comparison of gastric cancer guidelines from China, Japan, the republic of Korea, Europe, and the United States, revealing that although all guidelines adhere to the principles of evidence-based medicine, notable differences remain in methodology, therapeutic recommendations, update frequency, and review mechanisms. Key variations involve indications for neoadjuvant chemotherapy, criteria for endoscopic resection, and the extent of lymph node dissection, largely attributable to regional epidemiologic profiles, stage distribution at diagnosis, healthcare resource allocation, and health policy orientations. Nevertheless, the fundamental therapeutic principles and overarching goals of these guidelines are convergent: standardizing patient care, delivering high-quality treatment, incorporating the latest clinical trial evidence, and establishing expert consensus to inform policy-making. This review highlights how each guideline is developed, their unique elements, major differences, and the underlying reasons for these divergences.