In patients with gastric cancer and positive peritoneal lavage cytology or localized peritoneal metastasis, upfront chemotherapy followed by surgery yields better outcomes than surgery followed by chemotherapy.

• The 5-year overall survival rate is 39.9% for patients who received upfront chemotherapy, compared to 31.4% for those undergoing initial surgery (p=0.01).
• Those who convert to p0cy0 status before gastrectomy have the best prognosis, with a 5-year survival rate of 50.5%.

Surgeons should consider the sequence of treatment when planning interventions for these patients, emphasizing the potential benefits of neoadjuvant chemotherapy.