# The Role of Prophylactic HIPEC in High-Risk Gastric Cancer Patients: Where Do We Stand?

## TL;DR

Prophylactic HIPEC may improve survival in high-risk gastric cancer patients, but more research is needed to optimize its use.

## Contribution

This paper reviews current evidence on prophylactic HIPEC for high-risk gastric cancer and highlights the need for personalized treatment approaches.

## Key findings

- Prophylactic HIPEC improves overall and disease-free survival in high-risk gastric cancer patients.
- Treatment protocols and complication rates are heterogeneous, requiring further research.
- Large-scale randomized trials are needed to confirm the benefits of prophylactic HIPEC.

## Abstract

The use of hyperthermic intraperitoneal chemotherapy (HIPEC) for microscopic lesions is associated with a significant benefit in patients with peritoneal carcinomatosis (PC). For patients who are diagnosed with a malignancy with high potential to develop peritoneal metastases, the concept of prophylactic HIPEC has emerged. Prophylactic HIPEC appears to be useful and effective in treating patients with high-risk gastric cancer, improving both overall and disease-free survival. The heterogeneity of data regarding treatment protocols and complication rates suggests that further research is needed in order to develop optimal personalized therapeutic approaches. Quality of life also needs to be taken into account, given that it is equally important as the currently applied survival statistics.

For patients diagnosed with a malignancy at high risk of developing peritoneal metastases, the concept of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged. The aim of the present study is to assess the role of prophylactic HIPEC in gastric cancer patients at high risk of PC, based on the currently available data in the literature. In total, 14 RCTs and 16 non-RCTs were identified and included in the present review, with 1383 patients included in the RCTs (627 of whom underwent HIPEC) and 1647 patients included in the non-RCTs (with 609 undergoing HIPEC). Prophylactic HIPEC appears to be useful and effective in treating patients with high-risk gastric cancer, improving both overall and disease-free survival. The heterogeneity of data regarding treatment protocols and complication rates suggests that further research is necessary to develop optimal therapeutic approaches and personalized treatment options; in particular, large-scale randomized control trials are needed in order to elucidate the potential benefits associated with the use of prophylactic HIPEC.