Surgery for Gastric Carcinomatosis

In selected cases, yes: cytoreductive surgery with HIPEC can be undertaken with curative intent or to achieve prolonged disease control. Selection is stricter than in other origins, because gastric carcinomatosis behaves more aggressively. It requires limited peritoneal disease, good general condition and a previous response to chemotherapy.

Patients with limited peritoneal disease, good general condition and no distant metastases, always assessed at a multidisciplinary meeting. Two further factors weigh heavily: the response to previous chemotherapy and whether all visible disease can realistically be removed. Without complete cytoreduction, HIPEC brings no benefit in gastric cancer.

Those of major abdominal surgery: bleeding, infection, leaks at the bowel joins, and respiratory or thromboembolic complications. Combining it with intraperitoneal chemotherapy adds a risk of toxicity and of renal or haematological effects. In high-volume centres with specifically experienced teams, those complications are significantly reduced.

Yes. In gastric carcinomatosis, chemotherapy before surgery is in fact the usual sequence. It reduces the disease and, above all, shows how the tumour behaves: the patients who respond are the ones who benefit most from the operation. Having had chemotherapy does not rule surgery out, it prepares for it.

It is HIPEC given during a gastrectomy in patients at high risk of peritoneal recurrence, before any peritoneal disease is visible. The aim is to treat microscopic cells that may already have been shed into the abdomen. It is a selective indication, reserved for high-risk tumours and decided at a multidisciplinary meeting.

With imaging (CT, PET-CT and MRI), tumour markers and, in many cases, a diagnostic laparoscopy. That last step matters particularly in gastric cancer: imaging often underestimates peritoneal spread, and only direct inspection of the abdominal cavity, with cytology of the fluid, stages the disease properly.

Not always. When peritoneal disease is extensive or fails to respond to treatment, surgery brings no benefit. The approach is then based on systemic chemotherapy, on PIPAC or on treatment 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 a localised recurrence and good general condition, a further operation can be considered. The interval since the first surgery, the extent of the relapse and the response to systemic treatment are all weighed. In gastric carcinomatosis this second surgery is less frequent than in other origins.

The hospital stay is usually 7 to 14 days and full recovery takes two to three months. The return to normal eating is gradual, particularly if part of the stomach has been removed. Enhanced recovery protocols, with early mobilisation and nutritional support, shorten that process.

It is always advisable, because the criteria for operating on gastric carcinomatosis vary between centres. Many patients are told surgery is not an option without ever being assessed by a peritoneal surface team. A second opinion confirms whether you are a candidate for surgical treatment, and if you are not, it confirms that too.

In centres with demonstrated experience in peritoneal surface malignancy and enough case volume. In this disease, results depend directly on how many procedures of this type the team performs and on having a multidisciplinary board that reviews every indication. Our institute works to that model in Barcelona and Madrid.