Treatment of gastric cancer with peritoneal metastasis

Background Patients with gastric cancer spread to the peritoneum show a very poor prognosis. Median survival when treated with second-line chemotherapy is only 7 months. Objective This article aims to summarize diagnostic and therapeutic strategies for gastric cancer with peritoneal metastasis, according to current clinical evidence. Materials and methods In addition to the authors' own experience at a reference center for peritoneal malignancies, a literature search was conducted for current clinical studies using PubMed. Results A laparoscopy should be conducted in cases of locally advanced gastric cancer and integrated into pre-operative staging. This allows the response of peritoneal metastasis to pre-operative systemic therapy to be evaluated. Surgical treatment of gastric cancer with peritoneal metastasis, namely gastrectomy and surgical cytoreduction, should only be considered in selected cases and performed by experienced centers. The value of additional hyperthermic intraperitoneal chemotherapy (HIPEC) or pressurized intraperitoneal aerosol chemotherapy (PIPAC) procedures is currently being evaluated in clinical studies. Conclusion Staging laparoscopy can be used to exclude peritoneal metastasis with high certainty, which enables curative therapy. In peritoneal metastasis with low tumor load, surgical therapy with gastrectomy and cytoreduction can be carried out in selected cases and in a designated center.