Christodoulidis G, Agko SE, Koumarelas KE, Kouliou MN. Therapeutic strategies and prognostic challenges in linitis plastica. World J Exp Med 2025; 15(1): 96318 [DOI: 10.5493/wjem.v15.i1.96318]
Corresponding Author of This Article
Grigorios Christodoulidis, MD, PhD, Surgeon, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr
Research Domain of This Article
Surgery
Article-Type of This Article
Editorial
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/
Grigorios Christodoulidis, Marina Nektaria Kouliou, Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece
Sara Eirini Agko, Intensive Care Unit, Asklepios Paulinen Clinic Wiesbaden, Wiesbaden 65197, Germany
Konstantinos Eleftherios Koumarelas, Department of Emergency Medicine, General Hospital of Larissa, Larissa 41221, Greece
Author contributions: Christodoulidis G designed the overall concept and outline of the manuscript; Christodoulidis G, Agko ES, Koumarelas KE and Kouliou MN contributed to the discussion and design of the manuscript; Christodoulidis G, Agko ES, Koumarelas KE and Kouliou MN contributed to the writing, editing the manuscript, and review of literature.
Conflict-of-interest statement: Nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Grigorios Christodoulidis, MD, PhD, Surgeon, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr
Received: May 3, 2024 Revised: October 9, 2024 Accepted: November 29, 2024 Published online: March 20, 2025 Processing time: 236 Days and 17.3 Hours
Abstract
Gastric cancer ranks fifth as the most common cancer and third as the leading cause of death worldwide. Risk factors include advancing age, low-fiber diets, high salt intake and Helicobacter pylori infection. Diagnosis relies on histological examination following endoscopic biopsy with staging accomplished through various imaging modalities. Early gastric cancer is primarily managed via endoscopic resection, while non-early operable cases typically undergo surgery. Advanced cases are addressed through sequential chemotherapy lines, with initial treatment usually comprising a platinum and fluoropyrimidine combination. Linitis plastica (LP) is a rare, aggressive form of gastric cancer characterized by diffuse infiltration of the gastric wall, resulting in poor outcomes even after curative resection. The absence of a standardized definition contributes to uncertainty regarding the precise incidence of these tumors. LP is often diagnosed at advanced stages, with a reported median survival rate of approximately 4%-29%, despite “curative resection”. Its distinctive biological behavior includes perineural invasion, nodal metastasis, and peritoneal dissemination. The bleak prognosis for LP patients partly stems from delayed diagnosis and its aggressive biological nature, posing significant challenges for clinical management. Currently, no specialized treatment strategy exists for LP, and clinical approaches typically align with those used for general gastric cancer treatment. Surgical resection is the primary treatment, but the optimal surgical approach remains contentious. Recent studies have investigated the efficacy of neoadjuvant chemotherapy and radiotherapy in improving survival outcomes for LP patients. However, controversies persist regarding the role of adjuvant chemotherapy and postoperative radiotherapy. LP requires a multidisciplinary approach and personalized treatment strategies tailored to each patient’s condition. Further research is needed to elucidate optimal therapeutic interventions and improve outcomes for LP patients.
Core Tip: Linitis plastica (LP) gastric cancer poses a significant challenge due to its aggressive nature and poor prognosis. Early detection and personalized treatment strategies are essential for improving outcomes in LP patients. While surgery remains the mainstay of treatment, the role of adjuvant chemotherapy and postoperative radiotherapy is still under debate. Neoadjuvant chemotherapy, particularly with regimens such as docetaxel plus oxaliplatin and S-1, shows promise in enhancing survival rates for LP patients. Multidisciplinary collaboration and further research are necessary to optimize therapeutic interventions and improve outcomes in this challenging subset of gastric cancer.
