Carcinomatosis in gastric cancer: the potential for cytoreductive surgery and intraperitoneal chemotherapy

In gastric cancer, the finding of a positive peritoneal cytology is considered stage IV metastatic disease. Such patients behave similarly to patients with distant metastatic disease (1). Frank peritoneal carcinomatosis carries even a worse prognosis. In a recent randomized trial comparing up front surgery for patients with metastatic gastric cancer to treatment with chemotherapy alone without surgery, including patients with limited peritoneal disease or disease limited to retroperitoneal lymph nodes, initial surgery resulted in no survival benefit compared to chemotherapy treatment alone (2). Survival trended inferior with poorer therapy tolerance in patients undergoing surgery. The application of aggressive surgical intervention in patients with peritoneal confined metastases including cytoreductive surgery and gastrectomy remains a subject of considerable and ongoing controversy.