Hyperthermic intraperitoneal chemotherapy for preventing and treating peritoneal metastasis in gastric cancer

Table 1 Results of hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer peritoneal metastasis

Ref.	Study design	Intervention	Median overall survival (month)	Key findings
Khomiak et al[30], 2024	Retrospective study	CRS + HIPEC	18.1:9.3	CRS + HIPEC was associated with significantly improved OS in a selected population
Lin et al[31], 2024	Clinical trial	CRS + HIPEC + systemic chemotherapy	27	L-CRS followed by HIPEC is safe and feasible, offering potential survival benefits for limited peritoneal metastasis

The median overall survival data presented are derived from studies with distinct designs and patient selection criteria. Khomiak et al[30] (retrospective study) compared cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC) vs systemic chemotherapy alone, while Lin et al[31] (prospective phase II trial) assessed local CRS combined with HIPEC and systemic chemotherapy in a selected cohort with limited peritoneal disease. The survival differences may reflect variations in treatment intensity, patient selection, and study design. Both studies support the potential role of CRS + HIPEC in selected patients, although generalizability may be influenced by selection bias and heterogeneity across studies. CRS: Cytoreductive surgery; HIPEC: Hyperthermic intraperitoneal chemotherapy; L-CRS: Local cytoreductive surgery.

Table 2 Technological improvements in hyperthermic intraperitoneal chemotherapy for gastric cancer

Specific technology/approach	Advantages	Challenges
Laparoscopic HIPEC	Reduces recovery time and postoperative complications	Proven safe and effective in selected patients; requires specialized training
PIPAC	Suitable for patients ineligible for CRS/HIPEC; low-dose localized delivery	Emerging alternative; role as supplement or alternative to HIPEC under study
Imaging + biomarkers + risk stratification	Maximizes therapeutic effect, reduces adverse reactions	Integrating multiple modalities for personalized pathways
Anti-HER2, anti-angiogenic drugs, programmed death 1/programmed death-ligand 1 inhibitors	Enhances synergy with HIPEC; potential for systemic and local control	Cutting-edge research area; optimal combinations and timing under investigation
Robot-assisted surgery, AR guidance, real-time molecular imaging	Improves surgical precision, reduces complications	Technologically advanced but cost and accessibility barriers
Genomic analysis + targeted therapy	Revolutionary potential for high-risk populations	Requires robust biomarkers and clinical validation

Listed technologies represent active innovations in hyperthermic intraperitoneal chemotherapy. Clinical integration depends on further research, technical maturation, and multidisciplinary collaboration. CRS: Cytoreductive surgery; HIPEC: Hyperthermic intraperitoneal chemotherapy; PIPAC: Pressurized intraperitoneal aerosolized chemotherapy; AR: Augmented reality.