- S. Gretschel
- P.M. Schlag
- Chirurgische Gastroenterologie
- Chir Gastronenterol 23 (4): 353-359
In the last years there has been a change in the treatment of locally advanced or metastasized gastric cancer. Remarkable tumor remission was achieved with new chemotherapy strategies, in part also including radiotherapy. These new results should lead to reconsideration of surgical resection as a salvage strategy in advanced gastric cancer. Multivisceral resection after neoadjuvant chemotherapy of a locally advanced cancer, not clearly R0 resectable, is intended to be curative because of the chance of tumor-free margins. A new interesting approach is the combination of surgical reduction of tumor burden with peritonectomy and hyperthermic intraperitoneal chemoperfusion in cases of localized peritoneal carcinomatosis (P1 and P2), which may increase disease-free and possible overall survival times. The evaluation of this new multimodal treatment concept requires carefully designed randomized clinical trials. Since there is no suitable non-surgical treatment alternative at this stage of disease with a very poor prognosis, extended cytoreductive surgical procedures combined with intraperitoneal/intravenous chemotherapy is a valuable new frontier in surgical oncology.