Current Evidence for the Use of HIPEC and Cytoreductive Surgery in Gastric Cancer Metastatic to the Peritoneum

Simple Summary Advanced gastric cancer (GCa) is associated with poor prognosis due to the challenge of peritoneal disease, the most common site of metastasis at initial diagnosis, staging laparoscopy, and recurrence. Unfortunately, current standards of care for peritoneal metastasis (PM) in GCa are palliative therapies, despite hyperthermic intraperitoneal chemotherapy (HIPEC) being a proven standard of care for other peritoneal malignancies. Fortunately, results from studies investigating the impact of HIPEC in patients suffering from GCa with PM are encouraging. Additionally, several ongoing trials may offer further data and some centers have incorporated HIPEC into their treatment of patients with metastatic GCa. HIPEC can potentially confer improved survival outcomes in select patients with GCa and PM, who historically have dismal outcomes, and further well-designed clinical trials are warranted. This manuscript provides a comprehensive review of the current evidence supporting the use of HIPEC and cytoreductive surgery (CRS) in patients suffering from GCa with PM.Abstract Gastric cancer (GCa) is an aggressive malignancy, representing the third leading cause of cancer mortality worldwide. The poor prognosis of GCa can be associated with the prevalence of peritoneal metastasis (PM). Current international and national GCa treatment guidelines only recommend palliative treatment options for patients with PM. Since the 1980s there have been multiple single arm trials, randomized controlled trials, and metanalysis investigating the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced GCa, with or without PM. Results from these studies have been encouraging, with some large-volume centers even incorporating HIPEC into their treatment algorithms for patients with advanced GCa. Additionally, there are several ongoing trials that, when completed, will increase our understanding of the efficacy of CRS & HIPEC in patients with GCa metastatic to the peritoneum. Herein we review the current evidence, ongoing trials, consensus guidelines, and future considerations regarding the use of CRS & HIPEC in patients suffering from GCa with PM.