<p>Gastric cancer is frequently diagnosed at an advanced stage, leading to a poor overall prognosis, particularly in regions without population-based screening. Stage IV disease, defined by distant metastases, is associated with dismal survival outcomes. Current management is primarily palliative, consisting of systemic therapy—chemotherapy, immunotherapy, or targeted agents tailored to molecular biomarkers. Despite the recent therapeutic advances, durable survival remains rare. In selected patients with limited metastatic disease, surgical resection has emerged as a potential therapeutic strategy, with reports of favorable oncological outcomes. Several international guidelines and consensus statements now acknowledge surgery as an option in patients who demonstrate stable disease after a period of systemic therapy. The central challenge is the accurate identification of patients most likely to benefit from surgical intervention and the precise delineation of low-volume metastatic disease. This review synthesizes the available evidence on the role of surgery in the management of metastatic gastric cancer.</p>