<p>The peritoneum is a frequently involved site of metastasis in gastrointestinal malignancies, posing a major risk to human health. In recent years, treatment methods such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have significantly prolonged the survival time of patients with gastrointestinal peritoneal metastases. With the continuous advancements in comprehensive treatment for peritoneal cancer, targeted therapy and immunotherapy are gradually being applied to patients with gastrointestinal peritoneal metastases. Gastrointestinal peritoneal metastases are now widely acknowledged as a regional abdominal disease. Consequently, preventing both localized abdominal and systemic recurrences has become a central focus in their diagnosis and management. This article systematically reviews the recurrence patterns of gastrointestinal peritoneal metastatic tumors following surgery, with an emphasis on intraperitoneal, single-site, and multi-site recurrence patterns. It also discusses factors influencing the time to recurrence, such as the degree of cytoreduction and the type of chemotherapy used. The importance of assessment tools for recurrence, such as tumor marker detection, imaging, and laparoscopy, is emphasized. Additionally, strategies for preventing recurrence are outlined, including tumor-free principles, adjuvant chemotherapy, HIPEC, and integrated traditional Chinese and Western medicine. The article highlights new advances in targeted therapy and immunotherapy, aiming to provide guidance for clinical practice and future research.</p>