Cytoreductive Surgery and Intraperitoneal Chemotherapy for Gastric Cancer
Summary
Gastric cancer remains a leading cause of cancer mortality worldwide, with peritoneal dissemination accounting for a substantial proportion of recurrences and treatment failures. Cytoreductive surgery seeks to remove all visible peritoneal tumour deposits, thereby reducing tumour burden to microscopic levels. Intraperitoneal chemotherapy complements this approach by delivering cytotoxic agents directly into the peritoneal cavity, achieving higher local drug concentrations while limiting systemic toxicity. Hyperthermic intraperitoneal chemotherapy (HIPEC) applies heated perfusate to enhance drug penetration and cytotoxicity, whereas pressurised intraperitoneal aerosol chemotherapy (PIPAC) uses aerosolisation under pressure to improve distribution over peritoneal surfaces. Optimal outcomes depend on careful patient selection, typically based on the peritoneal cancer index and the feasibility of achieving an R0 resection. Multimodal strategies that combine neoadjuvant systemic chemotherapy, cytoreduction with HIPEC and even early postoperative intraperitoneal chemotherapy have been adopted in specialised centres. Collectively, these interventions have extended survival in selected cohorts, reduced peritoneal recurrence and established a new paradigm for managing peritoneal metastases in gastric cancer. However, standardisation of techniques, refinement of patient stratification and wider adoption across regions remain challenges for global implementation.
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Cytoreductive Surgery and Intraperitoneal Chemotherapy for Gastric Cancer publication trend
The graph below shows the total number of articles in cytoreductive surgery and intraperitoneal chemotherapy for gastric cancer across all publications each year (not limited to Nature Index journals).
Technical terms
Cytoreductive surgery: Surgical removal of all visible tumour deposits from the peritoneal cavity to minimise residual disease.
Intraperitoneal chemotherapy: Direct administration of anticancer drugs into the peritoneal cavity to achieve high local concentrations.
Hyperthermic intraperitoneal chemotherapy (HIPEC): Heated intraperitoneal perfusion of chemotherapy during surgery to enhance cytotoxic effects and tissue penetration.
Pressurised intraperitoneal aerosol chemotherapy (PIPAC): Delivery of chemotherapy as a pressurised aerosol to improve distribution and uptake on peritoneal surfaces.
Conversion therapy: Use of systemic and intraperitoneal chemotherapy to downstage peritoneal disease, enabling subsequent surgical resection.
Peritoneal cancer index (PCI): Quantitative score assessing the extent and distribution of peritoneal metastases across defined abdominal regions.
R0 resection: Complete tumour removal with no microscopic residual disease, indicating negative surgical margins.
References
- Oncological outcomes of conversion therapy in gastric cancer patients with peritoneal metastasis: a large-scale retrospective cohort study. Gastric Cancer (2023).
- Intraperitoneal chemotherapy for peritoneal metastases of gastric origin: a systematic review and meta-analysis. British Journal of Surgery (2024).
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