To identify adequate surgical strategies for patients with incurable gastric cancer, long-term results in 228 patients with peritoneal metastasis were analyzed. There was a significant difference in survival between the 141 palliatively gastrectomized and the 87 non-gastrectomized patients. The prognostic factor both in all patients and in gastrectomized patients was the degree of peritoneal metastasis (hazard ratio 1.9073/1.2530) but none was selected in those not gastrectomized. In patients with slight peritoneal metastases (POCY1, P1), the prognostic factors were resection (hazard ratio 5.8631) and a tumor diameter less than 100 mm (hazard ratio 1.7762), but there were non where severe peritoneal metastases were present (P2, P3). Morbidity was frequent in palliation. Palliative gastrectomy is indicated in POCY1 or P1 cases with tumor diameters less than 100 mm. In such gastrectomy, lymph node dissection is limited to a little more than D1, which eradicates only macroscopically identifiable metastatic lymph nodes near the stomach.