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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2016; 22(3): 1114-1130
Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1114
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gastric cancer
Ramakrishnan Ayloor Seshadri, Olivier Glehen
Ramakrishnan Ayloor Seshadri, Department of Surgical Oncology, Cancer Institute (WIA), Chennai 600036, India
Olivier Glehen, Service de Chirurgie Viscérale et Endocrinienne, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite Cedex, France
Olivier Glehen, Université Lyon 1, EMR 3738, 69921 Oullins, France
Author contributions: Seshadri RA and Glehen O contributed equally to this paper; both authors were involved in designing the study, performing the literature research, writing and approving the final manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Olivier Glehen, Professor, Chief of Service, Service de Chirurgie Viscérale et Endocrinienne, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite Cedex, France. olivier.glehen@chu-lyon.fr
Telephone: +33-478-862371 Fax: +33-478-863343
Received: April 28, 2015
Peer-review started: May 5, 2015
First decision: August 26, 2015
Revised: September 22, 2015
Accepted: November 30, 2015
Article in press: November 30, 2015
Published online: January 21, 2016
Abstract

Gastric cancer associated peritoneal carcinomatosis (GCPC) has a poor prognosis with a median survival of less than one year. Systemic chemotherapy including targeted agents has not been found to significantly increase the survival in GCPC. Since recurrent gastric cancer remains confined to the abdominal cavity in many patients, regional therapies like aggressive cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been investigated for GCPC. HIPEC has been used for three indications in GC- as an adjuvant therapy after a curative surgery, HIPEC has been shown to improve survival and reduce peritoneal recurrences in many randomised trials in Asian countries; as a definitive treatment in established PC, HIPEC along with CRS is the only therapeutic modality that has resulted in long-term survival in select groups of patients; as a palliative treatment in advanced PC with intractable ascites, HIPEC has been shown to control ascites and reduce the need for frequent paracentesis. While the results of randomised trials of adjuvant HIPEC from western centres are awaited, the role of HIPEC in the treatment of GCPC is still evolving and needs larger studies before it is accepted as a standard of care.

Keywords: Gastric cancer, Peritoneal carcinomatosis, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy

Core tip: Peritoneal carcinomatosis (PC) associated with gastric cancer has a poor prognosis. Systemic chemotherapy is not very effective in this situation and therefore, regional therapies like cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) have been investigated to improve the survival of these patients. HIPEC has been used as an adjuvant after curative resection, in the treatment of established PC and in palliating intractable ascites in gastric cancer. This review looks at the current status of HIPEC in peritoneal metastasis due to gastric cancer.