Gastric Carcinomatosis: The Challenge
Peritoneal metastasis from gastric cancer represents one of the most difficult oncological scenarios, with historically poor prognosis when treated with systemic chemotherapy alone (median survival 6–12 months). The peritoneal surface acts as a barrier limiting drug penetration from systemic circulation.
HIPEC in Gastric Carcinomatosis
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) offers a locoregional approach that overcomes this barrier. By delivering heated chemotherapy directly into the peritoneal cavity, drug concentrations 20–30 times higher than systemic treatment can be achieved at the tumour site.
Patient Selection Is Critical
Not all patients with gastric carcinomatosis are candidates for CRS + HIPEC. Ideal candidates have: Limited peritoneal disease: Low Peritoneal Cancer Index (PCI ≤6). No or limited distant metastasis. Good performance status. Tumour biology favouring surgery: HER2-negative, no signet ring cell predominance in some protocols. Careful patient selection by an expert MDT at a high-volume centre is essential to maximise benefit and minimise harm.
Evidence and Results
The GASTRIPEC trial and other studies have provided evidence for CRS + HIPEC in highly selected gastric carcinomatosis patients. Median survival in selected patients at expert centres reaches 15–20 months, compared to 6–12 months with chemotherapy alone. R0 resection and low PCI are the strongest predictors of benefit.
Integration with Systemic Treatment
Modern management integrates CRS + HIPEC within a perioperative chemotherapy strategy. Induction chemotherapy assesses tumour responsiveness, systemic treatment consolidates results after surgery. The timing and combination of locoregional and systemic therapies is individualised by the MDT.
Have you been diagnosed with gastric carcinomatosis? At Quenet Torrent Institute our experts evaluate each case individually. Request a consultation or second opinion.