Simple SummaryThe presence of peritoneal carcinomatosis in patients with advanced gastric cancer has important implications for the management of this disease. For this reason, staging laparoscopy plays an important role in the preoperative diagnosis of peritoneal dissemination in these patients. A review of the current literature was performed in order to summarize the indications, advantages, and future perspectives of staging laparoscopy and peritoneal cytology in the diagnosis and management of advanced gastric cancer.AbstractA significant proportion of patients diagnosed with gastric cancer is discovered with peritoneal metastases at laparotomy. Despite the continuous improvement in the performance of radiological imaging, the preoperative recognition of such an advanced disease is still challenging during the diagnostic work-up, since the sensitivity of CT scans to peritoneal carcinomatosis is not always adequate. Staging laparoscopy offers the chance to significantly increase the rate of promptly diagnosed peritoneal metastases, thus reducing the number of unnecessary laparotomies and modifying the initial treatment strategy of gastric cancer. The aim of this review was to provide a comprehensive summary of the current literature regarding the role of staging laparoscopy in the management of gastric cancer. Indications, techniques, accuracy, advantages, and limitations of staging laparoscopy and peritoneal cytology were discussed. Furthermore, a focus on current evidence regarding the application of artificial intelligence and image-guided surgery in staging laparoscopy was included in order to provide a picture of the future perspectives of this technique and its integration with modern tools in the preoperative management of gastric cancer.