Although neoadjuvant therapy significantly improves tumor control rates and pathological complete response (pCR) rates, the tissue edema and fibrosis it induces obscure the anatomical planes of the gastric mesentery, thereby increasing surgical complexity and complication risks (e.g., increased intraoperative blood loss and prolonged operation time). The tissue alterations primarily manifest as: (1) Edema causing difficulties in identifying anatomical planes, obvious exudation in the surgical area, and tissues being prone to tearing. (2) Fibrosis leading to the disappearance of anatomical spaces, making dissection difficult and increasing the risk of collateral damage. To address these challenges, the following surgical quality control strategies are recommended: (1) Precise clinical staging to avoid overtreatment. (2) Prudent implementation of function-preserving surgery. Standard gastrectomy with D2 lymphadenectomy should still be adhered to currently. Exploration of reduced or omitted surgery should only be considered for specific patient groups. (3) Prioritize dissection of normal tissue areas, avoid entering incorrect anatomical planes, employ suction devices for assistance, and enhance team collaboration. Future efforts should focus on establishing an intraoperative tissue alteration evaluation system, advancing multimodal precision staging, exploring pathways for function-preserving surgery in clinical research, and optimizing perioperative treatment through multidisciplinary collaboration.