Figure 2.

Peritoneal-directed modalities and their roles in treatment and prophylactic strategies for GCPM. Catheter-based IPC has been evaluated in both adjuvant and neoadjuvant settings in the management of GCPM. The adjuvant combination of systemic and intraperitoneal chemotherapy may help downstage PM, allowing for conversion gastrectomy, whereas the role of adjuvant early postoperative intraperitoneal chemotherapy in the prevention of metachronous PM remains unclear. HIPEC is most commonly carried out in conjunction with cytoreductive surgery as a potentially curative strategy in patients with low-volume PM and potential for complete cytoreduction. A potential role exists for prophylactic HIPEC in patients with GC undergoing gastrectomy to prevent or reduce metachronous PM recurrence, with ongoing studies currently underway. Studies on PIPAC have thus far been limited to palliative treatment for patients with PM; the role of PIPAC in the treatment of GCPM requires further evaluation and is currently limited to the settings of clinical trials. GCPM—gastric cancer peritoneal metastasis; HIPEC—hyperthermic intraperitoneal chemotherapy; IPC—intraperitoneal chemotherapy; PIPAC—pressurized intraperitoneal aerosol chemotherapy.