Objective: To compare the efficacy between preoperative and postoperative docetaxel-based adjuvant chemotherapy for locally advanced gastric cancer (LAGC). Methods: From February 2011 to February 2012, 72 patients definitely diagnosed with LAGC were randomized into observational group and control group. Patients in observational group underwent preoperative chemotherapy, while those in control group were subjected to postoperative chemotherapy. Patients in both groups were followed up for 12 months after treatment, and the cycles of chemotherapy, surgical resection rate and pathological remission rate, as well as the incidence of adverse reactions and complications between the two groups were compared. Results: In total, 189 cycles of chemotherapy were performed for the two groups, in which observational group accounted for 62.43% (118/189), and control group accounted for 37.57% (71/189); one cycle chemotherapy administration accounted for 4.24% (5/118) in observational group, which was 22.54% (16/71) in control group, and all differences were statistically significant (both P<0.05). The complete response rate was 27.78% (10/36) and partial response rate was 63.89% (23/36) in observational group, which was 8.33% (3/36) and 38.89% (14/36) respectively in control group, and the differences were statistically significant (both P<0.05). The difference in surgical resection rate and lymph node removal between the two groups showed no statistical significance (both P>0.05). The incidence of adverse reactions was significantly lower in observational group than that in control group (P<0.05), while the incidence of complications and re-operation between the two groups had no statistical significance (both P>0.05). Conclusion: Preoperative docetaxel-based adjuvant chemotherapy can significantly improve the therapeutic efficacy for LAGC patients, improve the tolerance of patients to chemotherapy, and reduce adverse reactions.