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Review
. 2024 Dec 31;17(1):100.
doi: 10.3390/cancers17010100.

Evolution in the Surgical Management of Gastric Cancer Peritoneal Metastases

Matthew Krell  1 , Suedeh Ranjbar  1 , Saige Gitlin  1 , Diego R Alvarez Vega  1 , Rachel Wilson  1 , Kenya Thrasher  1 , Zachary J Brown  1
Affiliations
Review

Evolution in the Surgical Management of Gastric Cancer Peritoneal Metastases

Matthew Krell et al. Cancers (Basel). .

Abstract

Despite therapeutic treatments and the growing utilization of multimodal therapies, gastric cancer (GC) remains a highly aggressive malignancy with high mortality worldwide. Much of the complexity in treating GC is due to the high incidence of peritoneal metastasis (PM), with mean overall survival typically ranging from 4 to 10 months. With current systemic therapy, targeted therapies, and immunotherapies continuing to remain ineffective for GC/PM, there has been a significant growing interest in intraperitoneal (IP) therapies for the treatment of GC/PM. In this review, we summarize the development of PM and evolving treatment strategies for GC/PM. Furthermore, we explore the various advancements and outcomes of IP therapies, including heated intraperitoneal chemotherapy (HIPEC), neoadjuvant HIPEC, and pressurized intraperitoneal aerosolized chemotherapy (PIPAC).

Keywords: HIPEC; PIPAC; cytoreductive surgery; gastric cancer; peritoneal metastasis.

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Conflict of interest statement

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Figures

Figure 1
Figure 1
Peritoneal Carcinoma Index (PCI). The Peritoneal Carcinoma abdomen is calculated by dividing the abdomen into 13 regions (0–12). The PCI is measured by assigning a score to each region based on tumor size and taking the sum of all regions; higher numbers correspond with higher peritoneal disease burden. In addition to assessing the burden of disease, several scoring systems have been developed to assess the completeness of cytoreduction. As HIPEC has been demonstrated to be effective with residual disease less than 2–3 mm, complete cytoreduction has been defined as CC-0 or CC-1 resection with no residual disease or limited deposits <2.5 mm remaining, respectively.
Figure 2
Figure 2
HIPEC and PIPAC. HIPEC involves the administration of chemotherapy in a heated perfusate to improve the efficacy of the chemotherapy. PIPAC delivers chemotherapy as an aerosolized substance under laparoscopic pressurization, leading to greater spatial distribution and tissue penetration of the drug.
See this image and copyright information in PMC

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