Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (HIPEC) for gastric adenocarcinoma: why haven't we reached the promised land?

摘要

Gastric adenocarcinoma (gastric cancer, GC) is the fourth most common cancer and the second leading cause of cancer death worldwide. There are major differences in the incidence of GC across countries and continents. Global incidence, as well as primary tumor location and histological type are constantly changing. In the US and most of Western Europe, there has been a marked decline in distal, intestinal type GC, while the incidence of proximal and Barrett's type adenocarcinoma of the gastric cardia and esophago-gastric junction has been increasing. The incidence of diffuse type adenocarcinoma, on the other hand, is largely unchanged [1]. Adenocarcinoma of the body and antrum predominates in developing countries, among African-Americans, and in lower socio-economic groups, whereas proximal tumors are more common in developed countries, among Caucasians, and in higher socio-economic classes. The main risk factors for adenocarcinoma of the body and antrum include Helicobacter pylori infection and predisposing dietary factors, whereas gastroesophageal reflux disease and obesity play important roles in the development of proximal stomach cancer.