Hyperthermic intraperitoneal chemotherapy in gastric cancer: Indications and technical notes

Synchronous and metachronous peritoneal carcinomatosis (PC) is the most important issue in gastric cancer (GC) recurrence. Progress in the therapeutic challenge posed by PC has been made through a new treatment consisting of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), developed over the last two decades. This chapter provides a review of the literature and recent results. Current indications for HIPEC in GC are: for curative purposes in addition to CRS in the treatment of PC; as palliative treatment for otherwise untreatable ascites; and as adjuvant treatment in the absence of PC for tumors infiltrating the serosal layer. There is abundant evidence that a multimodality approach offers survival benefits over surgery alone. In selected patients and in experienced centers, HIPEC after radical CRS can prolong survival and reduce peritoneal recurrences. The early identification of GC patients at high risk for peritoneal disease is a task for the future.