New data raises the question of whether surgery can be skipped for certain gastric and gastroesophageal junction cancers with high pathologic complete response rates.

• Patients with mismatch-repair deficient tumors have a 60% pathologic complete response to neoadjuvant immunotherapy.
• Those with mismatch repair intact tumors show about 20% pathologic complete response with chemo-immunotherapy.

Surgeons should consider omitting surgery in select patients while emphasizing shared decision-making, especially given the high morbidity and mortality associated with surgical procedures.

• Long-term data supporting surgery omission remains limited.