Gastric Cancer with Peritoneal Metastases: Current Status and Prospects for Treatment

SIMPLE SUMMARY: Peritoneal metastases from gastric cancer have a poor prognosis. Their presence usually indicates the end-stage of the disease without curative treatment. However, the treatment of these patients with cytoreductive surgery and intraperitoneal chemotherapy has achieved promising results in different studies that have been published in recent years. However, this treatment approach is controversial. This review aims to update those studies to clarify whether surgery and intraperitoneal chemotherapy are beneficial for these patients. ABSTRACT: Gastric cancer (GC) has a poor prognostic and only one in four patients will have survived by 5 years after diagnosis. These poor results are due to the fact that most patients are diagnosed in advanced stages; peritoneal metastases (PM) are especially frequent and are difficult to treat. Currently, PM are considered a terminal stage of GC with a poor survival rate and are treated with palliative systemic chemotherapy. Since the beginning of the century, the treatment of PM from different origins has evolved; cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have become the treatment of choice for many malignant diseases that affect the peritoneum. CRS and HIPEC have also been used for patients with GC and PM, achieving survival results that have never been achieved when using systemic chemotherapy alone. The use of HIPEC can even prevent the development of peritoneal recurrences in patients with locally advanced GC as adjuvant therapy, can reduce the volume of peritoneal disease as neoadjuvant therapy, and can control symptoms in a palliative setting. The aim of this review is to collate the current scientific evidence regarding the treatment of PM of GC origin with surgery and intraperitoneal chemotherapy.