Role of intraperitoneal chemotherapy in gastric cancer

Peritoneal carcinomatosis (PC) is the most frequent mode of recurrence and metastasis in gastric cancer (GC). Apart from being potentially lethal, PC poses multiple complexities hindering cancer directed treatment, such as bowel obstruction, bowel perforation with bowel fistulae, nutritional deprivation and intractable malignant ascites; all of which finally culminate into agonizing death with immeasurable suffering. Recognition of PC as locoregional rather than a systemic disease has opened a treatment gateway where cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) are now increasingly utilized in the treatment pathways. In this review, we take a contemporary view on the management of gastric cancer at risk of PC or gastric cancer presenting with PC. We highlight the rationale of intraperitoneal chemotherapy and drugs used, followed by different scenarios and different modalities of intraperitoneal chemotherapy in light of the available literature.