Cytoreduction and intraperitoneal chemotherapy for carcinomatosis from gastric cancer

Abstract

Peritoneal carcinomatosis (PC) is the most common cause of metastasis from gastric cancer, and is detected in 30% of all gastric cancer patients [1]. However, the survival after surgery alone in patients with PC remains very poor [2,3]. PC is more frequently found in T3/T4 tumours and diffuse infiltrating type (Borrmann type 3/4) than T1/T2 tumours and localized type (Borrmann type 1/2). Peritoneal recurrence is found in about 60% after curative resection of patients with T3/T 4 tumours or diffuse infiltrating type. The poor results after treatment of PC are due to 1. low preoperative diagnostic accuracy of PC by the conventional diagnostic tools; 2. unavailability of effective systemic chemotherapeutic agents; 3. limited effect of surgical cytoreduction on survival; and 4. limited knowledge of the molecular mechanisms of peritoneal dissemination and possible targeted therapy. In this review, recent advances in the diagnosis and multimodal therapy for PC from gastric cancer are described.