Abstract: Peritoneal dissemination is commonly found in stage 4 gastric cancer patients and it is a key factor inthe prognosis of advanced gastric cancer. Radical resection for gastric cancer is still controversial and is con-sidered a palliative procedure. In patients with tumors penetrating through the serosa, the 5-year survival rateis low. Isolated cancer cells almost always exist when peritoneal metastasis is detectable by the naked eye.Patients with more tumor invasion out of the stomach have a lower survival rate. Combined use of biomarkersTPA, CA242, CA212, CA199, and CEA can increase the sensitivity of diagnosis. When residual tumor is clini-cally confirmed, intraoperative peritoneal chemotherapy should be administered. Anti-cancer agents such as MMC-CH, CDDP, VP-16 and controlled-release Sinofuan can be used. For patients with advanced gastriccancer, it is hard to predict the outcome of traditional D2 or D3 radical resection. D2 resection does not in-crease patient survival. No statistical significance was found in survival rates between D1 and D2 resection.Lymph node resection is only helpful for the identification of precise pathological staging. Expanded radical re-section does not improve the survival of patients with advanced gastric cancer.