Adjuvant Intraperitoneal Chemotherapy for Advanced Primary Gastric Cancer

Abstract

Background: For gastric cancer dissemination to the peritoneal cavity is a large part of the natural history. Also, cancer dissemination caused from the trauma of cancer resection can release viable cancer cells into the free peritoneal cavity; these cells implant and then progress as peritoneal carcinomatosis. Methods: From the medical literature a compilation of the results of adjuvant treatment of gastric cancer were reviewed and critically analyzed. A surgical rationale for integrating intraperitoneal chemotherapy into the management of advanced primary gastric cancer was sought. Results: A theoretical basis for the application of cytotoxic effects of cancer chemotherapy within the peritoneal cavity as a part of the primary management of gastric cancer was explored. Numerous manuscripts suggested that there was an increased morbidity and mortality with perioperative intraperitoneal chemotherapy but the added number of complications was manageable. These data suggest that intraperitoneal chemotherapy is of benefit in an adjuvant setting in gastric cancer patients who have a complete resection but who are at high likelihood of local-regional recurrence. Summary: Adjuvant intraperitoneal chemotherapy for advanced primary gastric cancer has a strong rationale. Numerous reports have established benefit. Wider application of this treatment modality is necessary through education, through additional clinical trials, and through continued publications from peritoneal surface malignancy treatment centers around the world.