Indication of CRS and HIPEC in Gastric Cancer-Related Peritoneal Metastasis

The ratio of peritoneal metastasis in advanced gastric cancer is approximately 40%. Patients with peritoneal metastasis of gastric cancer have limited treatment options and a poor prognosis of only 3 months survival without treatment. Systemic chemotherapy, as the first line treatment option according to national and international guidelines, improves survival up to 7–11 months. During the last two decades, the concept of cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy has been established and proved survival benefit in selected patients with median survival up to >15 months. Factors such as a low Peritoneal Cancer Index (<6) and the completeness of cytoreduction are the most important predictive factors for survival after surgery, but also more recently biologic and pathologic markers have been discovered and are under validation.