The treatment strategy for locally advanced gastric cancer is at a critical juncture, transitioning from traditional perioperative chemotherapy to a paradigm of immuno-combination therapy. Low pathological complete response rate, high postoperative recurrence rate, treatment intolerances of some patients under neoadjuvant chemotherapy model are key points. In recent years, the successful application of immune checkpoint inhibitors in advanced gastric cancer has driven their shift into the perioperative setting. This article summarizes the latest clinical trial data on perioperative immunotherapy for locally advanced gastric cancer and integrates advances in both domestic and international research, and further explores precision treatment strategies based on molecular subtypes such as programmed death ligand 1, microsatellite instability-high/deficient mismatch repair, human epidermal growth factor receptor 2 and Claudin 18.2, as well as the prospects of “chemotherapy-free” and “surgery-free” approaches for microsatellite instability-high patients. The aim is to provide a comprehensive, evidence-based reference for safety challenges of perioperative immunotherapy within clinical practice and future research directions.