Exciting translational research is underway to develop predictors of response to therapy and early detection of intraabdominal recurrence after multimodal treatment of advanced solid cancers. Despite efforts and high costs, however, no accurate prognostic or predictive markers have been established for clinical use. Considering the high developmental complexity of molecular cancer predictors, the idea of second-look laparoscopy is too simple. Nevertheless, it may have a central clinical value. Could second-look laparoscopy, as it is proposed by Inoue et al. [1], be used in applied sciences as a diagnostic tool to control, assess, and possibly change adjuvant or palliative systemic treatment after gastrectomy for gastric cancer? A robust and early assessment of treatment response is, particularly in this era, crucial due to very high costs and long-term duration of combined systemic modern chemotherapy regimen and targeted therapy. Evidence of disease progression during this multimodal expensive therapy can lead to a rational decision for cessation of treatment. Indeed, based on the results of an appropriate phase 3 randomized controlled trial [2], the addition of trastuzumab to chemotherapy for patients with human epidermal growth factor receptor type 2 (HER2) advanced, recurrent, or metastatic gastric cancer is suggested [3]. However, despite the significant improvement in response, namely, progression-free survival, the overall survival benefit by the addition of trastuzumab was 12%. Therefore, despite tailoring of trastuzumab treatment specifically to HER2-positive patients, a substantial proportion of these patients do not benefit. We need an ontime assessment to monitor these patients and stop this expensive therapy if peritoneal recurrence or disease progression occurs. To evaluate this diagnostic and therapeutic response approach, Inoue et al. [1] performed a study on secondlook laparoscopy for gastric cancer. Why may this report, published in the October issue of Surgical Endoscopy, have important implications? Peritoneal dissemination is the greatest challenge in the management of gastric cancer for the following reasons. First, peritoneal recurrence is the main cause of treatment failure and death from cancer among patients with an advanced, potentially curable stage of the disease who undergo laparoscopic gastrectomy with D2 node dissection and adjuvant treatment [4–11]. Second, a considerable proportion of these patients already have peritoneal metastases or positive peritoneal cytology results without visible metastatic disease at initial surgery. Third, besides peritoneal cytology, which at the initial stage of peritoneal dissemination requires open or laparoscopic surgery [12, 13], no other robust predictor of the disease exists. Indeed, even the modern imaging positron emission tomography (PET) has limitations for accurate diagnostic staging. Fourth, despite the advent of this exciting cancer genome era [14], it seems that long-term efforts will be required to develop robust genomic predictors of an individual patient risk for peritoneal recurrence and response to a therapy. Therefore, the results of this Japanese study merit our consideration. Inoue et al. [1] report on a second-look laparoscopy for 21 patients who had no clinical evidence of O. Zoras Department of General Surgery, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece