| Preoperative laparoscopy is mandatory to assess PCI and to obtain peritoneal cytology |
| Patients with GC and PM should be referred to experienced centers in the treatment of peritoneal malignancies |
| Patients with limited and potentially resectable PM (PCI ≤6) should be treated with a multimodal approach |
| We recommend 4 preoperative cycles of systemic chemotherapy with FLOT (fluorouracil, leucovorin, oxaliplatin and docetaxel), followed by cytoreductive surgery (CRS) with HIPEC, and then another 4 cycles of FLOT |
| The HIPEC currently in use at Hospital of Fuenlabrada is cisplatin 75 mg/m2 during 60 minutes |
| Neoadjuvant laparoscopic HIPEC or NIPS (neoadjuvant intraperitoneal and systemic chemotherapy) have shown good results, and can be preoperatively used in experienced centers, but in the context of clinical trials |
| EPIC (early postoperative intraperitoneal chemotherapy) can be added to CRS and HIPEC in patients with good performance status in experienced centers |
| Patients with GC and unresectable PM must be treated with palliative systemic chemotherapy. Laparoscopic HIPEC or PIPAC (pressurized intraperitoneal aerosol chemotherapy) can be used to improve quality of life of the symptomatic patients, in referral centers |
