Published online Oct 15, 2018. doi: 10.4251/wjgo.v10.i10.282
Peer-review started: July 19, 2018
First decision: August 2, 2018
Revised: August 7, 2018
Accepted: August 12, 2018
Article in press: August 13, 2018
Published online: October 15, 2018
Peritoneal carcinomatosis (PC) from gastric cancer has traditionally been considered a terminal progression of the disease and is associated with poor survival outcomes. Positive peritoneal cytology similarly worsens the survival of patients with gastric cancer and treatment options for these patients have been limited. Recent advances in multimodality treatment regimens have led to innovative ways to care for and treat patients with this disease burden. One of these advances has been to use neoadjuvant therapy to try and convert patients with positive cytology or low-volume PC to negative cytology with no evidence of active peritoneal disease. These strategies include the use of neoadjuvant systemic chemotherapy alone, using neoadjuvant laparoscopic heated intraperitoneal chemotherapy (NLHIPEC) after systemic chemotherapy, or using neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) in a bidirectional manner. For patients with higher volume PC, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been mainstays of treatment. When used together, CRS and HIPEC can improve overall outcomes in properly selected patients, but overall survival outcomes remain unacceptably low. The extent of peritoneal disease, commonly measured by the peritoneal carcinomatosis index (PCI), and the completeness of cytoreduction, has been shown to greatly impact outcomes in patients undergoing CRS and HIPEC. The uses of NLHIPEC and NLHIPEC plus NIPS have both been shown to decrease the PCI and thus increase the opportunity for complete cytoreduction. Newer therapies like pressurized intraperitoneal aerosol chemotherapy and immunotherapy, such as catumaxomab, along with improved systemic chemotherapeutic regimens, are being explored with great interest. There is exciting progress being made in the management of PC from gastric cancer and its’ treatment is no longer futile.
Core tip: Peritoneal carcinomatosis (PC) from gastric cancer, along with positive peritoneal cytology, are associated with poor overall outcomes. The treatment of patients with this disease burden has greatly improved and new multimodality treatment regimens have been introduced. Some of these include neoadjuvant laparoscopic heated intraperitoneal chemotherapy and bidirectional therapies like neoadjuvant intraperitoneal and systemic therapy. Appropriate patient selection remains crucial for optimal outcomes but we can be optimistic about the prospects for carefully selected patients with PC from gastric cancer.