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International Journal of Surgical Oncology
Volume 2014, Article ID 912418, 7 pages
http://dx.doi.org/10.1155/2014/912418
Review Article

The Treatment of Peritoneal Carcinomatosis in Advanced Gastric Cancer: State of the Art

1General Surgery Department, Spedali Civili, Chirurgia Generale 3, Piazzale Spedali Civili, 25121 Brescia, Italy
2General Surgery Department, Papa Giovanni XXIII Hospital, 42121 Bergamo, Italy
3Emergency Surgery Department, Ospedale Maggiore, 43121 Parma, Italy

Received 18 July 2013; Revised 20 November 2013; Accepted 2 January 2014; Published 17 February 2014

Academic Editor: George H. Sakorafas

Copyright © 2014 Giulia Montori et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.