Which patient is going to benefit from surgical cytoreduction with intraperitoneal chemotherapy (for manifest peritoneal metastases)?

The gastric cancer with peritoneal metastases still represents a serious problem in the oncological surgery, whereas the peritoneal metastases arising from colorectal cancer can be successfully treated using a multimodal therapy concept consisting of systemic chemotherapy, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. The best survival rates in patients suffering from peritoneal metastases of gastric cancer have been reported by the ToGa trial, in patients with HER-2 positive expression who received standard chemotherapy and trastuzumab. Cytoreductive surgery and HIPEC are increasingly wining a place in the multimodal therapy of gastric cancer with peritoneal metastases, the criteria for such an aggressive therapy are strict and the operability needs to be previously assessed by laparoscopic exploration. Interesting new data are awaited from the German GASTRIPEC study and from the French GASTRICHIP study.