Gastric adenocarcinoma peritoneal carcinomatosis: a narrative review

Abstract

Background and objective: To describe the diagnosis, workup, management, and areas of active research for peritoneal carcinomatosis (PC) arising from gastric adenocarcinoma (GA). The peritoneum is a common site of metastasis and recurrence for GA. Unlike other cancers of the peritoneal surface, there are no approved locoregional techniques to address peritoneal disease in GA. PC has a unique natural history, therapeutic response, and outlook that sets it apart from solid organ metastases.

Methods: A search of PubMed and Google Scholar databases was performed for the terms "Gastric Adenocarcinoma Peritoneal Carcinomatosis" for English articles published between 2000 and October, 2021. A narrative review was undertaken to summarize literature pertaining to current diagnosis and management strategy of PC from GA. Future directions of diagnosis and treatment were discussed, including intraperitoneal chemotherapy and molecular diagnosis.

Key content and findings: Incidence of carcinomatosis varies between Asia and Western populations, driving important differences in therapeutic algorithms and clinical trial eligibility. Determination of the extent of PC is a diagnostic challenge, with surgical staging as the most important modality. Systemic chemotherapy is the standard of care for patients with carcinomatosis. Intraperitoneal chemotherapy holds promise for patients with PC, but techniques are still considered experimental due to the paucity of data demonstrating improved survival.

Conclusions: PC from gastric cancer represents both a significant clinical challenge and an area of great therapeutic potential.

Keywords: Gastric; cancer; carcinomatosis; hyperthermic intraperitoneal chemotherapy (HIPEC); peritoneal.

Figure 1

Algorithm of GA diagnosis and management in Western populations. CT, computed tomography; CRS, cytoreductive surgery; EUS, endoscopic ultrasound; HIPEC, hyperthermic intraperitoneal chemotherapy; PC, peritoneal carcinomatosis; PIPAC, pressurized intraperitoneal aerosol chemotherapy; IPCP, intraperitoneal chemotherapy port.

Figure 2

CT scan of patient with foreshortened small intestinal mesentery, representing end-stage tumor invasion (permission: Jeremy L. Davis). CT, computed tomography.