Abstract
Due to limited systemic treatment options, peritoneal carcinomatosis of gastric origin is still associated with a dismal outcome and is claimed a terminal disease. In the past, surgery had not been considered as a potential treatment option. However, there is emerging evidence that in selected patients, locoregional treatment modalities including cytoreductive surgery of peritoneal carcinomatosis can improve survival in patients with gastric cancer. These operative procedures are complex and challenging, and a high surgical expertise of the treating physician is necessary to prevent major postoperative morbidity and mortality with a delay of further systemic therapy. This review summarizes our current knowledge and personal experience regarding the techniques of cytoreductive surgery for peritoneal metastasis of gastric origin.
Highlights
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This review summarizes our current knowledge and personal experience regarding the techniques of cytoreductive surgery for peritoneal metastasis of gastric origin
The indication for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastatic gastric cancer is limited to patients who have synchronous peritoneal metastases with a low peritoneal cancer index (PCI) score [1,2,3,4] and a very high probability of achieving a complete macroscopic cytoreduction
Summary
The parietal peritonectomy can be performed with electro-evaporative surgery using a small ball tip and high-voltage cautery for a safe resection margin and coagulation of small vessels to control bleeding. It is important to avoid entering the pleural space during dissection. The use of bipolar scissors may be helpful to control the removal of infiltrating nodules with spare resection of diaphragmatic muscle. As the procedure will include 90 min of HIPEC administration, it may be reasonable to expedite the procedure using sealing devices
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