Fig. 2.

Fifty-one years old female patient after R1 gastrectomy, postoperative chemotherapy (FLOT), and radiochemotherapy (5-FU) for GC, intestinal type, pT3 pN2 pM1 (per). Videolaparoscopy (a1) and CT scan (a2) at PIPAC#1 showing multiple small bowel involvement (white arrows) and radiological diffuse small bowel thickening (red arrows). At PIPAC # 4, videolaparoscopy shows a complete macroscopic response (b1) and CT a complete radiological response according to RECIST 1.1 criteria (b2). Number sign: micropump placed into the abdomen during laparoscopy. Asterisk: local peritonectomy scar. Multiple biopsies confirm major remission with extensive fibrosis and isolated vital tumor cells. Patient was alive 148 days after 1^st PIPAC with a KI of 90 %