To explore the clinical significance of laparoscopy combined with peritoneal exfoliative cytology in the precise staging and clinical diagnosis and treatment of patients with stage Ⅳb gastric cancer (advanced gastric cancer with distant metastasis with a single unresectable factor).

The clinical data of 618 consecutive patients with gastric cancer admitted to the Fourth Hospital of Hebei Medical University from October 2015 to October 2018 were retrospectively analyzed, the clinical imaging stage of the patients was stage Ⅳb and the follow-up data were complete. They were divided into two groups according to different treatment plans: direct chemotherapy group (direct systemic chemotherapy) and laparoscopy group (laparoscopy combined with abdominal exfoliation cytology, the treatment plan was determined according to the results of the exploration), the treatment and prognosis between the two groups were compared.

There were 285 cases in the direct chemotherapy group, and the 2-year overall survival rate was 46.67%. In the laparoscopy group, there were 333 cases with 2-year overall survival rate of 59.46%, including 185 cases (55.56%) of P₀CY₀, 85 cases (25.53%) of P₀CY₁, 63 cases (18.92%) of P₁CY₁, and the 2-year survival rates were 68.65%, 57.65% and 34.92% respectively (P<0.001). There was a statistically significant difference in the 2-year overall survival rate between the two groups (P<0.001). The 2-year survival rate of patients with liver metastasis, lung metastasis, ovarian metastasis, lymph node metastasis and left supraclavicular lymph node metastasis in the laparoscopy group was significantly better than that in the direct chemotherapy group (P<0.05).

Laparoscopy combined with abdominal exfoliative cytology helps to discover hidden metastasis in the abdominal cavity, meanwhile it can provide a new diagnosis and treatment mode, laparoscopy confirmed diagnosis-hyperthermic intraperitoneal chemotherapy, for the treatment of patients with stage Ⅳb gastric cancer with abdominal metastasis, which will significantly improve clinical decision-making.