Carcinomatosis of gastric origin

In selected cases, yes: cytoreductive surgery with HIPEC can be considered with curative intent or to achieve long-term control of the disease. Selection is stricter than for other origins, because gastric carcinomatosis is biologically more aggressive. Limited peritoneal disease, good general condition and a prior response to chemotherapy are required.

Patients with limited peritoneal disease, good general condition and no distant metastases, always assessed by the multidisciplinary board. Two further factors weigh: the response to previous chemotherapy and the real possibility of removing all visible disease. Without complete cytoreduction, HIPEC brings no benefit in gastric cancer.

Those of major abdominal surgery: bleeding, infection, leakage at the bowel joins and respiratory or thromboembolic complications. The combination with intraperitoneal chemotherapy adds a risk of toxicity and of kidney or blood-related problems. At high-volume centers with teams with specific experience, these complications are significantly reduced.

Yes. In fact, in gastric carcinomatosis chemotherapy is usually given before surgery. It serves to reduce the disease and, above all, to see how the tumor behaves: the patients who respond are the ones who benefit most from the operation. Having received chemotherapy does not rule out surgery; it prepares for it.

With imaging tests (CT, PET-CT and MRI), tumor markers and, in many cases, a diagnostic laparoscopy. The latter is especially important in gastric cancer: imaging often underestimates peritoneal spread, and only a direct view of the abdominal cavity, with cytology of the fluid, allows the disease to be staged properly.

Not always. When the peritoneal disease is extensive or does not respond to treatment, surgery brings no benefit. The approach is then based on systemic chemotherapy, PIPAC or treatments aimed at controlling symptoms. The multidisciplinary board decides which option fits each case and reviews that decision over time.

In well-selected patients, surgery with HIPEC can improve survival and quality of life compared with systemic treatment alone. The benefit depends entirely on selection: limited disease, good general condition and complete cytoreduction. Outside that profile, no advantage has been shown and the indication does not hold.

In selected cases with localized recurrence and good general condition, a new operation may be considered. The time since the first surgery, the extent of the relapse and the response to systemic treatment are assessed. In gastric carcinomatosis this second operation is less common than for other origins and is always decided by the board.

The hospital stay is usually 7 to 14 days and full recovery takes between 2 and 3 months. The return to a normal diet is gradual, especially if part of the stomach has been resected. Enhanced recovery protocols, with early mobilization and nutritional support, shorten that process.

At centers with proven experience in surgery for peritoneal carcinomatosis and enough case volume. In this disease, the results depend directly on how many operations of this kind the team performs and on having a multidisciplinary board that reviews each indication. Our institute works with that model in Barcelona and Madrid.