ObjectiveTo summarize the research progress of tumor-associated macrophages (TAM) in immunotherapy and drug resistance of gastric cancer, and provide new ideas for the treatment of gastric cancer. MethodThe literatures about tumor-associated macrophages in immunotherapy and drug resistance of gastric cancer at home and abroad in recent years were searched and reviewed. ResultsThe incidence and mortality of gastric cancer in China were significantly higher than those in other countries. Surgical treatment remained the primary approach for gastric cancer, and targeted therapy combined with immunotherapy had become the standard first-line treatment for advanced gastric cancer. TAM were a large population of immune cells present in the tumor immune microenvironment and had emerged as novel therapeutic targets and prognostic indicators in individualized treatment strategies. As the relationship between TAM and malignant tumors was further elucidated, TAM was expected to become a key target for the development of novel cancer therapeutics. However, some patients developed resistance during treatment. Recent preclinical and clinical studies had demonstrated that targeting TAM had yielded promising results in gastric cancer treatment. ConclusionsThe mechanism of TAM and the key factors driving the phenotypic changes of TAM in the microenvironment of gastric cancer remain to be further study. How to inhibit the tumor promoting effect of TAM will provide new clues for the future treatment of gastric cancer.