胃癌作为全球高发的消化道恶性肿瘤，仍是全球肿瘤疾病负担的重要来源。传统根治性手术长期以器官切除与淋巴结清扫为核心范式，该模式构成局部进展期胃癌治疗的重要基础。超级微创手术(SMIS)超越单一切除逻辑，以保全器官解剖完整性、保留固有生理功能及精准根治病灶为核心理念，为胃癌干预提供了新的演进方向。与此同时，胃癌并非单纯局部病灶，其发生、进展和治疗反应受免疫微环境、细胞谱系状态及分子异质性共同影响。本文立足肿瘤的全身性疾病属性，结合精准分型与治疗策略演进的证据，剖析胃癌在早期、进展期及晚期不同演化阶段下的机体免疫微环境与全身免疫状态差异，系统探讨新辅助治疗与超级微创局部精准清除的时序选择逻辑，旨在构建"器官保全＋病灶根治＋免疫重建＋全身调控"的一体化治疗模式，从而为胃癌的个体化、功能化诊疗提供理论依据与实践参考。

Gastric cancer remains a common gastrointestinal malignancy and a major contributor to the global cancer burden.Conventional radical surgery has long relied on organ resection and lymph node dissection as its central paradigm, providing an important foundation for the treatment of locally advanced gastric cancer.Super minimally invasive surgery (SMIS) moves beyond a simple resection-oriented logic by emphasizing preservation of anatomical integrity, maintenance of inherent physiological function, and precise eradication of the lesion.This concept offers a potential direction for the evolution of gastric cancer intervention.Meanwhile, gastric cancer should not be regarded solely as a local lesion; its occurrence, progression, and therapeutic response are jointly shaped by the immune microenvironment, cellular lineage states, and molecular heterogeneity. From the perspective of the systemic nature of tumors, this article integrates evidence from precision classification and evolving treatment strategies, analyzes differences in the immune microenvironment and systemic immune status across early, locally advanced, and advanced gastric cancer, and discusses the sequential logic of neoadjuvant therapy followed by SMIS-based local precise eradication. The aim is to outline an integrated treatment model combining organ preservation, lesion eradication, immune reconstruction, and systemic regulation, thereby providing a theoretical and practical reference for individualized and function-oriented management of gastric cancer.