Paul H Sugarbaker Peritoneal Surface Oncology Group International Also , clinic response. This kind of patients eat better , lower pain , weight gain. So, we might start thinking about prehabilitation during the systemic chemo.

Guillermo Peritoneal Surface Oncology Group International All of my long-term survivors with gastric cancer plus PM had NIPEC for 6 months. Yes, at this institution we would place a port and treat with bidirectional chemotherapy.

Peritoneal Surface Oncology Group International Guillermo The resections required in this patient are extremely well tolerated and carry a minimal morbidity. Small bowel anastomoses rarely if ever leak. Subtotal gastrectomy with reconstruction is a very safe surgery. This is a small price to pay for making the patient disease-free.

Peritoneal Surface Oncology Group International Paul H Sugarbaker Guillermo That sounds like a borderline case. However We did a similar case a few years ago and the patient was recurrence free for 18 months. Survived for 30 months. Obviously palliative but most certainly prolonged survival. Likewise this patient is palliative, but may prolong survival

Peritoneal Surface Oncology Group International Paul H Sugarbaker Even though, best results are known from PCI 6 or lower , in this time wit CCO (complete CRS ) we would proceed with HIPEC. If patient is in good intraop situation. Safety first.

Peritoneal Surface Oncology Group International Guillermo All of the surgery performed in this patient and the HIPEC carry an extremely low morbidity. The caveat regards patients who develop post-gastrectomy pancreatitis that was seen in 10% of our total gastrectomy patients who required lesser sac peritonectomy.

Peritoneal Surface Oncology Group International Guillermo These patients had a low mortality but a very long hospital stay.

Peritoneal Surface Oncology Group International Paul H Sugarbaker Quality of surgery and chances for a Complete CRS comes from training and learning curve. To be able to do this in a center with a TEAM from anesthesia to nurses familiar with this cases are KEY to be successful for patient and positive feedback to the related personnel

Peritoneal Surface Oncology Group International Guillermo The 2022 PSOGI Consensus advocated cisplatin (75 mg/m2) with mitomycin (15 mg/m2). I would reduce the cisplatin to 50 mg/m2. Our routine is to use continuous infusion 5-FU for 24 hours.

Peritoneal Surface Oncology Group International Guillermo Yan K et al. in 2019 published his RCT. The experimental arm received HIPEC plus oxaliplatin and 5-FU. HIPEC was repeated every other day for a total of 4 HIPEC treatments. Excellent results. This approach needs further clinical application.

Peritoneal Surface Oncology Group International Guillermo If the patient requires nutritional support while in the hospital, he would get a PICC line and parenteral feeding. This is our least expensive and lowest morbidity approach to nutritional support in the hospital.

Peritoneal Surface Oncology Group International Guillermo Feeding jejunostomy tubes have caused both short-term and long-term problems at this institution. We would not recommend a percutaneous jejunostomy.

Guillermo Peritoneal Surface Oncology Group International Guillermo, I agree with your approach. There are some patients who are very slow to recover adequate nutrition. Home TPN in USA is available anywhere and quite inexpensive. If patients are slow to recover, we recommend home TPN.

Peritoneal Surface Oncology Group International Guillermo Very difficult to plan adjuvant treatment until a full pathology report with a molecular analysis of the specimen is available.

Peritoneal Surface Oncology Group International Guillermo I would think the life expectancy of this patient is 1 year. The median survival depends a lot on the start time for measurement. Is it at the time of initial diagnosis? Is it at the time of CRS + HIPEC? Few patients make it past 1 year.

Peritoneal Surface Oncology Group International Paul H Sugarbaker Still , a lot to do in the prevention arm. This is the usual clinic presentation in Mexico , locally adavance gastric cancer. In the treatment approach, TEAMWORK , explore all possibilities and talk clear with patient and family .

Peritoneal Surface Oncology Group International Guillermo I agree with the 2022 PSOGI Consensus. HIPEC prolongs survival when used as an adjuvant to surgery in patients at high risk for PM. It also prolongs survival by approximately 6 months when used in patients with PM and a low PCI.

Peritoneal Surface Oncology Group International Guillermo In patients with a high PCI, prolonged intraperitoneal and systemic chemotherapy, if the institution is prepared for this treatment, should be considered. The goal on these patients conversion surgery.

Peritoneal Surface Oncology Group International Guillermo Long-term preoperative intraperitoneal chemotherapy was not considered in the 2022 PSOGI consensus.