The detection of peritoneal dissemination of gastric cancer is the weakness of current imaging technology. However, after opening the abdominal cavity, the doctor found that the metastases of gastric cancer had “spilled” all over the abdominal cavity and the patient lost the possibility of surgical treatment. We often hear the patient’s family members lamenting, “If I had known this, I would not have let him/her suffer from this”, while sighing, we do notice that there is a certain blind spot in the detection of peritoneal dissemination of gastric cancer in current imaging. Wang Jun, Department of General Surgery, Huashan Hospital, Fudan University, said that the diameter of lesions of peritoneal dissemination of gastric cancer is often smaller than that of peritoneal dissemination nodes of colorectal and appendiceal cancers, and the current imaging technology is difficult to detect peritoneal dissemination lesions of 5-8 mm and smaller, especially metastases of small intestinal mesentery, of which the sensitivity of enhanced CT, which is most popular among gastric surgeons, is only 11% for lesions less than 5 mm in diameter. In addition, MRI and PET/CT, the so-called “radar for monitoring life”, are also insensitive to peritoneal dissemination of gastric cancer due to the specific biological behavior and metabolism of peritoneal dissemination nodes, so preoperative assessment of intra-abdominal metastases by imaging and PCI scoring are limited. A Japanese authority on peritoneal dissemination of gastric cancer showed that of 44 patients with a PCI score of ≤6 on preoperative CT examination, only 29 patients (66%) had a true PCI score of ≤6 intraoperatively, and 12 of these patients (41.3%) had a PCI score of >7 on preoperative CT examination, so patients with a PCI score of ≤6 and an apparently good prognosis could not be correctly diagnosed by preoperative Therefore, the correct diagnosis cannot be made by preoperative CT examination for patients with a PCI score of ≤6 and an apparently good prognosis, which may result in patients not receiving timely and correct treatment. What to do? With the progress of medical technology, the concept of minimally invasive surgical treatment has gradually gained popularity. At present, laparoscopic surgery is the mainstay, and gastrointestinal surgery has become the most applied field of laparoscopic surgery. Recently, laparoscopic staging has been introduced into the diagnosis of peritoneal dissemination of gastric cancer; this technique possesses high accuracy in diagnosing metastatic lesions in the small intestinal mesentery. The diagnostic accuracy of laparoscopic exploration for peritoneal dissemination has been reported to be about 92%. In a foreign study, 97 patients with gastric cancer with peritoneal dissemination underwent full laparoscopic exploration, resulting in only 2 patients (2.1%) with a near 100% accuracy rate of downstaging. What are the advantages of laparoscopic exploration for peritoneal dissemination of gastric cancer? The main advantage of laparoscopic exploration is the ability to score PCI for intraperitoneal metastases and to understand the distribution and size of peritoneal metastases, and it has been demonstrated that laparoscopic PCI score has good correlation with open data. Laparoscopic biopsies can provide conclusive histologic and cytologic evidence, making laparoscopic techniques a reliable tool for evaluating the efficacy of neoadjuvant intraperitoneal chemotherapy. Recently, laparoscopic warm chemotherapy has been developed and two Western researchers, Facchiano and Valle, reported on 57 patients treated with laparoscopic warm chemotherapy and found complete clinical regression of ascites in all patients. Laparoscopic warm chemotherapy allows better penetration of the drug into the peritoneal tumor and peritoneum due to the higher intra-abdominal pressure generated by the closed abdominal warm chemotherapy. A study from the same Japanese authority showed that 25 patients with peritoneal dissemination of gastric cancer underwent laparoscopic warm peritoneal chemotherapy with an average operative time of 152 minutes and an average postoperative hospital stay of 10.7 days, with no case deaths or complications and a one-year survival rate of 67%. Thus, it seems that this new technique is a safe and effective treatment for malignant ascites. The laparoscopic technique avoids huge abdominal wall incisions due to minimal trauma and the risk of postoperative incisional infection and dehiscence, complications that are prone to occur in patients with advanced tumors and can further induce other complications such as abdominal infection, ascites leakage, electrolyte disturbances, and other complications leading to deterioration of systemic conditions.