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Sugarbaker. J Cancer Metastasis Treat 2018;4:7 Journal of Cancer
DOI: 10.20517/2394-4722.2017.67 Metastasis and Treatment

Review Open Access

Gastric cancer: prevention and treatment of
peritoneal metastases

Paul H. Sugarbaker

Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology, MedStar Washington Hospital Center,
Washington, DC 20010, USA.
Correspondence to: Dr. Paul H. Sugarbaker, Center for Gastrointestinal Malignancies, Program in Peritoneal Surface Oncology,
MedStar Washington Hospital Center, 106 Irving St., NW, Suite 3900, Washington, DC 20010, USA.
E-mail: Paul.Sugarbaker@medstar.net

How to cite this article: Sugarbaker PH. Gastric cancer: prevention and treatment of peritoneal metastases. J Cancer Metastasis Treat
2018;4:7. http://dx.doi.org/10.20517/2394-4722.2017.67
Received: 25 Nov 2017 First Decision: 3 Jan 2018 Revised: 8 Jan 2018 Accepted: 18 Jan 2018 Published: 9 Feb 2018

Science Editor: Masayuki Watanabe Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Gastric cancer is an aggressive malignancy that may metastasize through the bloodstream to the liver, through lymphatics
to regional lymph nodes, or by penetration of the peritoneal lining of the stomach to result in seeding of the abdominal
and pelvis surfaces. Peritoneal metastases are the most common mode of cancer dissemination. Technologies to prevent
or treat peritoneal metastases from advanced gastric cancer are presented in this manuscript. The world’s literature, both
recent and over the past three decades, was reviewed in order to identify publications that present information regarding
gastric cancer peritoneal metastases. Over one dozen randomized controlled trials to test perioperative chemotherapy
for prevention of peritoneal metastases were reviewed. All of the trials performed with regional chemotherapy during or
shortly after gastrectomy were positive. The clinical data regarding the treatment of peritoneal metastases diagnosed
at the time of primary cancer resection or in follow-up were reviewed. Neoadjuvant intraperitoneal and systemic
chemotherapy shows that some long-term survivors occur after these treatments were combined with cytoreductive
surgery and gastrectomy. Similar treatments are advocated for primary gastric cancer with cytology positive for gastric
cancer but no visible implants. Surgery for gastric cancer should be combined with perioperative systemic and regional
chemotherapy in order to maximally benefit patients with this disease by reducing the negative impact of peritoneal
metastases on survival.

Keywords: Hyperthermic intraperitoneal chemotherapy, normothermic intraoperative intraperitoneal chemotherapy,
early postoperative intraperitoneal chemotherapy, intraperitoneal chemotherapy, gastric cancer, peritoneal metastases,
carcinomatosis

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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