{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:04:10Z","timestamp":1792011850255,"version":"4.4.0"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Peritoneal metastases from gastric cancer (GCPM) represent a significant clinical challenge in terms of therapeutic options and prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has demonstrated promising survival benefits within a multimodal approach, particularly in carefully selected patients. Methods: This retrospective single-center study evaluated outcomes in patients with synchronous GCPM treated with CRS + HIPEC following neoadjuvant chemotherapy. The primary endpoints included overall survival (OS), disease-free survival (DFS), and identification of prognostic factors associated with poor outcomes. Additionally, we sought to characterize patients achieving long-term survival (OS \u2265 24 months). Results: The median OS and DFS were 18 and 13 months, respectively. A peritoneal cancer index (PCI) \u2265 7 and major postoperative complications were independently associated with reduced survival. Recurrence was significantly linked to PCI \u2265 7 and signet ring cell histology. Stratification by survival outcome identified PCI \u2265 7 as the only statistically significant variable differentiating average- and long-survival groups. Moreover, elevated PCI was independently associated with a higher incidence of major postoperative complications. Conclusions: CRS + HIPEC may offer a survival advantage over the use of systemic therapy exclusively in appropriately selected patients, particularly those with limited peritoneal disease burden. These results underscore the importance of accurate patient selection to balance surgical risks and maximize oncological benefits in the treatment of GCPM.<\/jats:p>","DOI":"10.3390\/jpm15070300","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T09:38:27Z","timestamp":1752140307000},"page":"300","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluating the Long-Term Impact of Cytoreductive Surgery for Gastric Cancer with Peritoneal Metastasis: Are We on the Right Path?"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6025-2222","authenticated-orcid":false,"given":"Cecilia","family":"Orsini","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1618-3131","authenticated-orcid":false,"given":"Matteo","family":"Aulicino","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"D\u2019Annibale","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"},{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Cantelmo","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0720-6224","authenticated-orcid":false,"given":"Sara","family":"Totaro Aprile","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8309-079X","authenticated-orcid":false,"given":"Paolo","family":"Catania","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Barberis","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8040-2231","authenticated-orcid":false,"given":"Federica","family":"Ferracci","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"},{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2007-0969","authenticated-orcid":false,"given":"Miriam","family":"Attalla El Halabieh","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Abatini","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Lodoli","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3981-1145","authenticated-orcid":false,"given":"Andrea","family":"Di Giorgio","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Strippoli","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Center, UOC Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Pacelli","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"},{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Santullo","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. 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Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1245\/s10434-022-12761-0","article-title":"Cytoreduction and HIPEC for Gastric Carcinomatosis: Multi-Institutional Analysis of Two Phase II Clinical Trials","volume":"30","author":"Green","year":"2023","journal-title":"Ann. Surg. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1007\/s10120-019-00969-1","article-title":"The Efficacy of Treatment Options for Patients with Gastric Cancer and Peritoneal Metastasis","volume":"22","author":"Rau","year":"2019","journal-title":"Gastric Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1245\/s10434-011-1631-5","article-title":"Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: Final results of a phase III randomized clinical trial","volume":"18","author":"Yang","year":"2011","journal-title":"Ann. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.21037\/jgo-20-284","article-title":"A Narrative Review of Intraperitoneal Chemotherapy and Cytoreductive Surgery (CRS) for Peritoneal Metastases in Gastric Cancer","volume":"12","author":"Boerner","year":"2021","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3170","DOI":"10.1245\/s10434-021-11316-z","article-title":"Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Combined with Surgery: A 12-Year Meta-Analysis of This Promising Treatment Strategy for Advanced Gastric Cancer at Different Stages","volume":"29","author":"Zhang","year":"2022","journal-title":"Ann. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1200\/JCO.22.02867","article-title":"Effect of Hyperthermic Intraperitoneal Chemotherapy on Cytoreductive Surgery in Gastric Cancer with Synchronous Peritoneal Metastases: The Phase III GASTRIPEC-I Trial","volume":"42","author":"Rau","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Al-Batran, S.-E., Lorenzen, S., Riera, J., Caca, K., Mueller, C., Stange, D.E., Zander, T., Bolling, C., Homann, N., and Gaedcke, J. (2024). Effect of Chemotherapy\/Targeted Therapy Alone vs. Chemotherapy\/Targeted Therapy Followed by Radical Surgical Resection on Survival and Quality of Life in Patients with Limited-Metastatic Adenocarcinoma of the Stomach or Esophagogastric Junction: The IKF-575\/RENAISSANCE Phase III Trial. J. Clin. Oncol., 42.","DOI":"10.1200\/JCO.2024.42.17_suppl.LBA4001"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.ejca.2008.10.030","article-title":"Validation of Novel Imaging Methodologies for Use as Cancer Clinical Trial Endpoints","volume":"45","author":"Sargent","year":"2009","journal-title":"Eur. J. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.ejca.2016.03.081","article-title":"RECIST 1.1-Update and Clarification: From the RECIST Committee","volume":"62","author":"Schwartz","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/00000421-198212000-00014","article-title":"Toxicity and Response Criteria of the Eastern Cooperative Oncology Group","volume":"5","author":"Oken","year":"1982","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/978-1-4613-1245-1_13","article-title":"Peritoneal Carcinomatosis: Natural History and Rational Therapeutic Interventions Using Intraperitoneal Chemotherapy","volume":"81","author":"Sugarbaker","year":"1996","journal-title":"Cancer Treat. Res."},{"key":"ref_15","unstructured":"Amin, M.B., Greene, F.L., Edge, S.B., Compton, C.C., Gershenwald, J.E., Brookland, R.K., Meyer, L., Gress, D.M., Byrd, D.R., and Winchester, D.P. (2017). AJCC Cancer Staging Manual, American Joint Committee on Cancer. [8th ed.]."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of Surgical Complications: A New Proposal with Evaluation in a Cohort of 6336 Patients and Results of a Survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2757","DOI":"10.1016\/j.ejso.2021.05.016","article-title":"Prognostic Impact of Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Gastric Cancer Patients: A Meta-Analysis of Randomized Controlled Trials","volume":"47","author":"Granieri","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"7528","DOI":"10.1245\/s10434-022-12312-7","article-title":"Impact of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy in the Treatment of Gastric Cancer with Peritoneal Carcinomatosis: A Systematic Review and Meta-Analysis","volume":"29","author":"Martins","year":"2022","journal-title":"Ann. Surg. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Aulicino, M., Santullo, F., D\u2019annibale, G., Abatini, C., El Halabieh, M.A., Orsini, C., Barberis, L., D\u2019agostino, L., Tersigni, I., and Pacelli, F. (2024). Efficacy and Insights from an Extensive Series of Cytoreductive Surgery for Peritoneal Neoplasms: A High-Volume Single-Center Experience. Cancers, 16.","DOI":"10.3390\/cancers16244229"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s00423-023-03163-1","article-title":"Gastric Cancer with Peritoneal Metastases: A Single Center Outline and Comparison of Different Surgical and Intraperitoneal Treatments","volume":"408","author":"Santullo","year":"2023","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Al-Batran, S.-E., Goetze, T.O., Mueller, D.W., Vogel, A., Winkler, M., Lorenzen, S., Novotny, A., Pauligk, C., Homann, N., and Jungbluth, T. (2017). The RENAISSANCE (AIO-FLOT5) Trial: Effect of Chemotherapy Alone vs. Chemotherapy Followed by Surgical Resection on Survival and Quality of Life in Patients with Limited-Metastatic Adenocarcinoma of the Stomach or Esophagogastric Junction\u2014A Phase III Trial of the German AIO\/CAO-V\/CAOGI. BMC Cancer, 17.","DOI":"10.1186\/s12885-017-3918-9"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Association Fran\u00e7aise de Chirurgie, Glehen, O., Gilly, F.N., Arvieux, C., Cotte, E., Boutitie, F., Mansvelt, B., Bereder, J.M., Lorimier, G., and Quenet, F. (2010). Peritoneal Carcinomatosis from Gastric Cancer: A Multi-Institutional Study of 159 Patients Treated by Cytoreductive Surgery Combined with Perioperative Intraperitoneal Chemotherapy. Ann. Surg. Oncol., 17, 2370\u20132377.","DOI":"10.1245\/s10434-010-1039-7"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1245\/s10434-015-5081-3","article-title":"Patients with Peritoneal Carcinomatosis from Gastric Cancer Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Is Cure a Possibility?","volume":"23","author":"Chia","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2615","DOI":"10.1245\/s10434-019-07450-4","article-title":"Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Gastric Cancer with Peritoneal Carcinomatosis: Multicenter Study of Spanish Group of Peritoneal Oncologic Surgery (GECOP)","volume":"26","author":"Manzanedo","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0140-6736(00)49915-0","article-title":"The Distribution of Secondary Growths in Cancer of the Breast","volume":"133","author":"Paget","year":"1889","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1002\/ags3.12515","article-title":"International Retrospective Cohort Study of Conversion Therapy for Stage IV Gastric Cancer 1 (CONVO-GC-1)","volume":"6","author":"Yoshida","year":"2021","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1200\/JCO.1995.13.1.8","article-title":"Oligometastases","volume":"13","author":"Hellman","year":"1995","journal-title":"J. Clin. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Manzanedo, I., Pereira, F., P\u00e9rez-Viejo, E., and Serrano, \u00c1. (2023). Gastric Cancer with Peritoneal Metastases: Current Status and Prospects for Treatment. Cancers, 15.","DOI":"10.3390\/cancers15061777"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2911","DOI":"10.1007\/s12094-023-03155-z","article-title":"Morbimortality After 1321 Consecutive CRS + HIPEC Procedures: Seeking Excellence in Surgery for Peritoneal Surface Malignancy","volume":"25","year":"2023","journal-title":"Clin. Transl. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Santullo, F., Abatini, C., El Halabieh, M.A., Ferracci, F., Lodoli, C., Barberis, L., Giovinazzo, F., Di Giorgio, A., and Pacelli, F. (2022). The Road to Technical Proficiency in Cytoreductive Surgery for Peritoneal Carcinomatosis: Risk-Adjusted Cumulative Summation Analysis. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.877970"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/7\/300\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:07:39Z","timestamp":1760033259000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/7\/300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,10]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jpm15070300"],"URL":"https:\/\/doi.org\/10.3390\/jpm15070300","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,10]]}}}