Gastric cancer is a common malignant tumor globally, particularly in East Asia (including China, Japan, and South Korea), where it exhibits high incidence and mortality rates. In China, gastric cancer ranks third among all cancers in terms of mortality, posing a severe threat to public health. The gastric cancer diagnosis and treatment guidelines published by the Chinese Society of Clinical Oncology (CSCO) and the National Comprehensive Cancer Network (NCCN) are essential tools guiding clinical practice. These guidelines encompass various aspects, including diagnosis, surgery, perioperative treatment, and postoperative follow-up, and are updated annually based on the latest clinical data. They provide evidence-based recommendations to guide diagnosis and treatment, offering standardized therapeutic advice to help physicians make better decisions in complex cases. Both guidelines share consistent views on the recommendation of treatment drugs for advanced gastric cancer, the importance of molecular biomarker testing, and the application of immunotherapy for advanced gastric cancer. However, they differ in recommendations regarding perioperative treatment strategies, neoadjuvant treatment or regimens, postoperative adjuvant therapy, the extent of lymph node dissection during surgery, and gastrointestinal reconstruction. The CSCO guidelines emphasize comprehensive treatment strategies tailored to China's specific conditions, include more detailed annotations, and have updated some novel antibody drugs. In contrast, the NCCN guidelines rely more on international data, offer more unified treatment recommendations, and provide a wider range of therapeutic drug options along with more detailed nutritional monitoring and management. Overall, both guidelines play significant roles in promoting the standardization and personalization of gastric cancer treatment, offering valuable guidance for clinicians. Early diagnosis and resistance-related issues highlighted in the guidelines still require further solutions. Future research on gastric cancer will continue to focus on advancing immunotherapy and targeted therapy to improve patients' survival rates and quality of life. By comparing the two guidelines, medical practitioners can provide more standardized and personalized optimal treatment plans for gastric cancer patients. They are encouraged to actively engage in relevant clinical trials to explore new drugs and treatment methods, so as to enhance treatment efficacy and patient survival rates.