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Advances in diagnosis and surgical techniques have improved the conditions of patients with gastric cancer. Peritoneal dissemination, however, is still the most frequent cause of death, and the prognosis of patients with peritoneal metastasis of gastric cancer is extremely poor (Balfour, 1973; Hioki et al.,2010; Maruyama, 1987; Makino et al., 2010; M. Yamamoto et al., 2009). In patients with serosal invasion, about half develop peritoneal recurrence and die from the disease within the first 2 years of follow-up, even if curative resection is performed (Abe et al., 1995; Ikeguchi et al., 1994; Kaibara et al., 1987; Moriguchi et al., 1992; Ribero et al., 1998). Furthermore, it has been reported that the survival span of the patients with cytology-positive peritoneal lavage fluid and without the macroscopic peritoneal dissemination (CY+/P-) of gastric cancer was almost the same as that of patients with P+ (Boku, et al., 1990; Shimada et al., 2003), and the 5-year survival rate of patients with CY+/Pis only 2% (Bando et al., 1999). Accordingly, the treatment recommendations for gastric cancer in the event of positive cytology range from palliative chemotherapy to attempts at neo-adjuvant therapies followed by surgical resection. However, the results of published randomized clinical trials of adjuvant perioperative intra-peritoneal chemotherapy have not fully demonstrated any significant improvement in survival as compared with surgery alone, especially in the cases with P+ (Cunliffe & Sugarbaker, 1989; Cheong et al., 2007; Hagiwara et al., 1992; Ikeguchi et al., 2005; Kunisaki et al., 2002; Sauter et al., 1994). Therefore, a reliable and appropriate standard prophylactic regimen for peritoneal recurrence in patients with gastric cancer needs be established. Clinical and pathologic factors that have been found to correlate with the presence of positive cytology are usually at an advanced stage of the disease (Burke et al., 1998; Iitsuka et al., 1979; Koga et al., 1984; Ribeiro et al.,2006; Yawata et al.,1998). The most likely cause is the presence of intra-peritoneal free cancer cells from the serosal surface of the primary cancer and their implantation on the peritoneum. Furthermore, our previous study proved

Establishment of the Standard Prophylactic Strategy for Peritoneal Recurrence and Proposal of the Optimal Therapeutic Protocol for Gastric Cancer