Advanced gastric cancer: new perspectives of treatment

https://doi.org/10.4081/joper.2016.29

Authors

  • Matteo Nardi Department of General Surgery, Infermi Hospital, Rimini, Italy.
  • Luca Ansaloni Departments of General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Giulia Montori Departments of General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Marco Ceresoli Departments of General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Giacomo Crescentini Department of General Surgery, Infermi Hospital, Rimini, Italy.
  • Gian Marco Palini Department of General Surgery, Infermi Hospital, Rimini, Italy.
  • Filippo Paratore Department of General Surgery, Infermi Hospital, Rimini, Italy.
  • Mattia Trevisan Department of General Surgery, Infermi Hospital, Rimini, Italy.
  • Nicola Zanini Department of General Surgery, Infermi Hospital, Rimini, Italy.
  • Lucia Morganti Department of General Surgery, Infermi Hospital, Rimini, Italy.
  • Federico Coccolini | federico.coccolini@gmail.com Departments of General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.

Abstract

The prognosis in patients with advanced gastric cancer with carcinosis remains poor with a median survival of less than one year. High rates of peritoneal recurrence of patients undergoing resection with potentially curative intent are strictly related with lymphatic spread and penetration of the serosa. To increase survival rates, during the last thirty years different strategies about screening and treatment have been tested and proposed. Early detection of occult peritoneal micrometastasis is a base step to reduce local and serosa recurrences and to offer a tailored surgical and neoadjuvant therapeutic treatment. The complete cytoreductive surgery, however, remains the cornerstone of treatment. It could be associated with different combinations of chemotherapy regimens. Adjuvant, neoadjuvant and intraperitoneal chemotherapy have been demonstrated effective in improving the survival. In the last years, a few new molecules have been introduced which enhance the effect of chemotherapy by biologically targeting its objective. Lastly the prevention of macroscopic peritoneal carcinosis in all those patients at high risk due to serosal infiltration by treating them with intraperitoneal chemotherapy has been demonstrated to be one of the future winning approaches. In patients with peritoneal carcionosis, multimodal comprehensive treatment should be mandatory, with a pivotal role of intraperitoneal chemotherapy associate to CC0 cytoreduction. Neoadjuvant chemotherapy followed by cytoreductive surgery and intraperitoneal chemotherapy gave promising results. The new molecules as monoclonal antibodies seem to improve outcomes.

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Published
2016-12-20
Info
Issue
Section
Reviews
Keywords:
Gastric cancer, neoadjuvant chemotherapy., peritoneal metastasis, carcinomatosis, neoadjuvant chemotherapy
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How to Cite
1.
Nardi M, Ansaloni L, Montori G, Ceresoli M, Crescentini G, Palini GM, Paratore F, Trevisan M, Zanini N, Morganti L, Coccolini F. Advanced gastric cancer: new perspectives of treatment. J Peritoneum [Internet]. 2016Dec.20 [cited 2020Aug.10];1(2). Available from: http://www.jperitoneum.org/index.php/joper/article/view/29

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