It has been difficult to improve the prognosis of the type 4 advanced gastric cancer because the peritoneal dissemination develops frequently. In the present study, the therapeutic strategy, an administration of chemotherapy followed by gastrectomy, for the type 4 advanced gastric cancer with positive lavage cytology (CY) was discussed. CY has changed to negative in 3 of 6 cases (50%) at the surgery and in 1 of another 3 cases during the post operative chemotherapy. MST was 1487 days (966-2354 days) in cases with negative CY after pre-operative treatment, while 193 and 395 days in another 2 cases remained in positive CY, respectively. It may be important to perform re-staging laparoscopy with the evaluation of CY after preoperative chemotherapy for the type 4 advanced gastric cancer with positive CY, because the survival was comparatively better in cases with the change from positive CY to negative CY after the treatment. In conclusion, the treatment strategy for the type 4 advanced gastric cancer with positive CY was to administer chemotherapy followed by curative intent surgery for the case with negative CY after pre-operative treatment, while the other regimen of chemotherapy administration for the case with positive CY remained.