Abstract
Gastric cancer (GC) is the fourth most common cancer and the second leading cause of cancer death in the world; 53–60% of patients show disease progression and die of peritoneal carcinomatosis (PC). PC of gastric origin has an extremely inauspicious prognosis with a median survival estimate at 1–3 months. Different studies presented contrasting data about survival rates; however, all agreed with the necessity of a complete cytoreduction to improve survival. Hyperthermic intraperitoneal chemotherapy (HIPEC) has an adjuvant role in preventing peritoneal recurrences. A multidisciplinary approach should be empowered: the association of neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), cytoreductive surgery (CRS), HIPEC, and early postoperative intraperitoneal chemotherapy (EPIC) could increase the rate of completeness of cytoreduction (CC) and consequently survival rates, especially in patients with Peritoneal Cancer Index (PCI) ≤6. Neoadjuvant chemotherapy may improve survival also in PC from GC and adjuvant chemotherapy could prevent recurrence. In the last decade an interesting new drug, called Catumaxomab, has been developed in Germany. Two studies showed that this drug seems to improve progression-free survival in patients with GC; however, final results for both studies have still to be published.
Highlights
Gastric cancer (GC) is the fourth most common cancer and the second leading cause of cancer death in the world [1, 2]
The prognosis of GC depends on stage and location: proximal gastric tumours have poorer prognosis compared to those in the pyloric antrum and when the disease is confined to the stomach mucosa, 5year survival is near to 95%, while the reported 5-year survival rate for advanced GC varies from 10 to 20% [5]
Hyperthermic intraperitoneal chemotherapy (HIPEC) results are better, but normothermic intraperitoneal chemotherapy (NIIC)’s are still statistically significant [8]. This meta-analysis demonstrated that adding postoperative intraperitoneal chemotherapy (PIC) to HIPEC has no additional effect on overall survival rates but it improves costs and toxicity
Summary
Gastric cancer (GC) is the fourth most common cancer and the second leading cause of cancer death in the world [1, 2]. Global incidence of primary tumour locations and the histological types are constantly changing: in United States and in Western Europe the incidence of esophagogastric junction (Barrett’s type) and gastric cardia adenocarcinoma is increasing [4] while there has been a reduction of incidence of distal GC since the 1970s, especially in Western countries [5]. The prognosis of GC depends on stage and location: proximal gastric tumours (i.e., cardia tumor) have poorer prognosis compared to those in the pyloric antrum and when the disease is confined to the stomach mucosa, 5year survival is near to 95%, while the reported 5-year survival rate for advanced GC varies from 10 to 20% [5]. 40% of GC deaths have hepatic metastases, while in 53–60% disease evolves through PC [3]
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