Prevention and Treatment of Peritoneal Metastases from Gastric Cancer

Abstract

Gastric cancer is a common and deadly disease. It is the fourth most commonly diagnosed cancer in the world with a 5-year survival rate of 25% [1, 2]. In follow-up, almost half of gastric cancer patients will develop peritoneal spread which results in a less than 5% 5-year survival rate [3–5]. Peritoneal metastases are a common finding in primary gastric cancer found in 5–20% of patients undergoing gastrectomy [6]. The peritoneum is also the most common location of first recurrence observed in about half of the patients [7]. Standard of care for treatment of primary or recurrence of gastric cancer involves surgery, intravenous chemotherapy, and radiotherapy. However, specific treatments for peritoneal metastases such as neoadjuvant systemic chemotherapy (NAC), neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), cytoreductive surgery (CRS), and perioperative chemotherapy which may include hyperthermic intraperitoneal chemotherapy (HIPEC) and/or early postoperative intraperitoneal chemotherapy (EPIC) are currently being explored [8]. CRS and HIPEC and/or EPIC are already considered standard of care for appendiceal peritoneal metastases, peritoneal mesothelioma, and a limited extent of peritoneal metastases from colorectal carcinomatosis [9–11]. Gastric cancer with peritoneal metastases is aggressive, and current treatment efficacy remains controversial. The following is an attempt to summarize the role and efficacy of NACS, NIPS, CRS, and HIPEC and/or EPIC as a treatment for peritoneal metastases of gastric cancer (Fig. 24.1).