Publication:

Management of peritoneal metastasis of gastric cancer

Peritoneal metastases (PM) from disseminations of gastric cancer, presented as a recurrence, its considered fatal with no definitive cure. newer agents like S1 and docetaxel have shown some advantage but nevertheless the median overall survival with the current first line chemotherapy is only 8 to 14 months which shows no great improvement when adding targeted therapy. A multidisciplinary approach combining cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has been developed. European and Far East studies reported long-term survival benefits in case of complete cytoreduction with 5-year survival rates up to 25%. In order to prevent peritoneal recurrence and to improve overall survival, adjuvant HIPEC is the most evidence-based indication for advanced-stage gastric cancer patients without PM. The rationale for immunotherapy is solid, with ongoing studies combining CRS and intraperitoneal immunotherapeutic agent. The detection of peritoneal cancer cells is the most reasonable way for identifying the metastasis risk after operation. Peritoneal washing appears to be a sensitive method. Thus, the prevention of peritoneal recurrence mandates the use of multiple modalities and locoregional treatments strategy.