Gastric Cancer with Peritoneal Metastases: Current Status and Prospects for Treatment

Abstract

Gastric cancer (GC) has a poor prognostic and only one in four patients will have survived by 5 years after diagnosis. These poor results are due to the fact that most patients are diagnosed in advanced stages; peritoneal metastases (PM) are especially frequent and are difficult to treat. Currently, PM are considered a terminal stage of GC with a poor survival rate and are treated with palliative systemic chemotherapy. Since the beginning of the century, the treatment of PM from different origins has evolved; cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have become the treatment of choice for many malignant diseases that affect the peritoneum. CRS and HIPEC have also been used for patients with GC and PM, achieving survival results that have never been achieved when using systemic chemotherapy alone. The use of HIPEC can even prevent the development of peritoneal recurrences in patients with locally advanced GC as adjuvant therapy, can reduce the volume of peritoneal disease as neoadjuvant therapy, and can control symptoms in a palliative setting. The aim of this review is to collate the current scientific evidence regarding the treatment of PM of GC origin with surgery and intraperitoneal chemotherapy.

The Role of Staging Laparoscopy for Gastric Cancer Patients: Current Evidence and Future Perspectives

“…On the other hand, patients with lower PCI may be candidates for aggressive surgery aiming to remove all the macroscopic peritoneal metastasis, followed by the administration of hyperthermic intraperitoneal chemotherapy (HIPEC), which has the goal of clearing the residual microscopic deposits. Indeed, during recent decades, cytoreductive surgery followed by HIPEC [41][42][43], as well as pressurized intraperitoneal aerosol chemotherapy (PIPAC) [44][45][46], has emerged as novel therapeutic options for patients with advanced GC with PC [47,48]. Despite the PCI cut-off of 12 proposed by Glehen et al in 2012 [49-51], the current literature recommends a PCI lower than 7 to achieve a complete cytoreduction [52,53].…”

“…Indeed, during recent decades, cytoreductive surgery followed by HIPEC [ 41 , 42 , 43 ], as well as pressurized intraperitoneal aerosol chemotherapy (PIPAC) [ 44 , 45 , 46 ], has emerged as novel therapeutic options for patients with advanced GC with PC [ 47 , 48 ]. Despite the PCI cut-off of 12 proposed by Glehen et al in 2012 [ 49 , 50 , 51 ], the current literature recommends a PCI lower than 7 to achieve a complete cytoreduction [ 52 , 53 ].…”

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in the Treatment of Gastric Cancer: Feasibility, Efficacy and Safety—A Systematic Review and Meta-Analysis

“…Despite this trend, GC remains a significant contributor and an important cause of cancer morbidity and mortality, characterized by an ongoing unfavorable prognosis [ 1 , 2 ]. Notably, it was estimated to rank as the fifth-most prevalent cancer globally in 2020, contributing to 8.0% of all cancer-related deaths [ 1 , 3 ]. The diagnosis rate has been approximated at 6.9 per 100,000 new cases annually.…”

“…In specific regions, particularly in Eastern Asia and Eastern Europe, gastric cancer ranks as the third-most frequently diagnosed cancer. However, its prognosis continues to be bleak due to usual late-stage diagnoses [ 1 , 3 , 5 ]. Peritoneal metastases are notably prevalent, occurring in 15 to 30.0% of patients at initial diagnosis.…”

“…Peritoneal metastases are notably prevalent, occurring in 15 to 30.0% of patients at initial diagnosis. Additionally, among patients treated with curative intent (via gastrectomy and systemic chemotherapy), 40 to 60.0% experience peritoneal metastasis as the sole site of recurrence [ 3 , 6 , 7 ].…”