Cheng ZW, Liang YZ, Wei M, Yan ZB, Sun GR, Cui XH, Yu WB. Prophylactic hyperthermic intraperitoneal chemotherapy for gastric cancer: Current evidence, persistent uncertainties, and future perspectives. World J Gastroenterol 2026; 32(30): 118763 [DOI: 10.3748/wjg.118763]
Corresponding Author of This Article
Wen-Bin Yu, MD, PhD, Professor, Department of General Surgery, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Jinan 250012, Shandong Province, China. wenbin_yu2003@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Cheng ZW, Liang YZ, Wei M, Yan ZB, Sun GR, Cui XH, Yu WB. Prophylactic hyperthermic intraperitoneal chemotherapy for gastric cancer: Current evidence, persistent uncertainties, and future perspectives. World J Gastroenterol 2026; 32(30): 118763 [DOI: 10.3748/wjg.118763]
Ze-Wei Cheng, Yi-Ze Liang, Meng Wei, Zhi-Bo Yan, Guo-Rui Sun, Xiao-Han Cui, Wen-Bin Yu, Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Cheng ZW and Yu WB contributed to conceptualization; Cheng ZW, Yu WB, Liang YZ, Wei M, Yan ZB, Sun GR, and Cui XH were involved in writing, reviewing, and editing; and all authors have read and approved the final version of the manuscript.
AI contribution statement: The authors used the AI tool DeepSeek during manuscript revision and proofreading. No part of the main text was AI-generated. All content is original authors’ work. The AI tool was used only for language polishing and grammar checking. The AI tool did not participate in study design or result interpretation. No images in the manuscript were AI-generated.
Supported by Horizontal Project of Shandong University, No. 6010123193, No. 6010121066, and No. 6010125120.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Wen-Bin Yu, MD, PhD, Professor, Department of General Surgery, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Jinan 250012, Shandong Province, China. wenbin_yu2003@163.com
Received: January 12, 2026 Revised: February 13, 2026 Accepted: April 22, 2026 Published online: August 14, 2026 Processing time: 193 Days and 23.9 Hours
Abstract
Peritoneal metastases remain a major cause of treatment failure and poor prognosis in locally advanced gastric cancer, with a substantial proportion of patients harboring occult peritoneal metastases undetectable by imaging and many developing peritoneal recurrences as the first site of relapse after curative resection. While cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has gained traction for established peritoneal metastases, the clinical role of prophylactic HIPEC in gastric cancer without established peritoneal metastases remains unsettled. Meta-analyses and recent trials offer conflicting evidence: Some demonstrate meaningful reductions in peritoneal recurrence alongside improved overall and disease-free survival, whereas others show no discernible survival advantage or recurrence benefit. Although prophylactic HIPEC for gastric cancer appears generally safe and does not materially increase overall severe complication rates, it carries distinct risks that demand vigilant monitoring, including renal impairment, pulmonary dysfunction, and hematologic toxicity. Patient selection is paramount, with serosal invasion, nodal burden, diffuse type histology, and positive peritoneal cytology emerging as key determinants of potential benefit in this gastric cancer population. Persistent heterogeneity in treatment protocols, spanning drug selection, timing, and perfusion parameters, further clouds consensus regarding the optimal application of prophylactic HIPEC in gastric cancer. Emerging technologies and synergistic combinations with novel systemic therapies provide new directions for optimizing the therapeutic effect of prophylactic HIPEC. This opinion review summarizes the current clinical evidence, existing controversies, and future research perspectives of prophylactic HIPEC in locally advanced gastric cancer, aiming to provide valuable insights for clinical practice and further research.
Core Tip: Prophylactic hyperthermic intraperitoneal chemotherapy aims to eliminate occult free cancer cells following curative gastrectomy for locally advanced gastric cancer, thereby reducing peritoneal recurrence. While meta-analyses suggest potential improvements in survival and peritoneal control, conflicting trial results and persistent protocol heterogeneity preclude definitive recommendations. Although prophylactic hyperthermic intraperitoneal chemotherapy appears generally safe, it carries distinct risks that demand vigilant monitoring, including renal impairment, pulmonary dysfunction, and hematologic toxicity. Optimal patient selection, guided by serosal invasion, nodal burden, diffuse histology, and positive peritoneal cytology, remains paramount. Ongoing trials and novel combinatorial strategies may help clarify its therapeutic role.
