Objective To investigate the rate of greater omentum metastasis in gastric cancer(GC). Methods General informations of patients with GC who underwent radical gastrectomy at Shanghai Ruijin Hospital in May 2020 were collected, and their clinicopathological characteristics were analyzed to find risk factors of greater omentum metastasis. Recurrence and survival were also assessed. Results A total of 59 patients with GC were included in the study, of which 2(3.4%) had greater omentum metastasis. One patient presented a pathological stage of pT4aN3bM0 and another ypT4bN1M0. The 3-year overall survival rate of patients in the study was 87.9%. Conclusions The rate of greater omentum metastasis was relatively low, and patients with greater omentum metastasis had an more advanced pathological stage. To further validate this clinical issue, a prospective randomized controlled clinical study should be conducted between radical gastrectomy with omentectomy and omentum-preserving radical gastrectomy.

Gastric cancer with peritoneal metastasis (GCPM) is a common and lethal manifestation of advanced gastric cancer, with a median survival of only 5-11 months. This consensus was developed by 30 experts from Asia (China, Japan, Korea, and Singapore) using the Delphi method and the GRADE evidence grading system. A total of 29 statements were formulated, covering the diagnosis and assessment of GCPM, indications for laparoscopic exploration and NIPS (normothermic intraperitoneal and systemic treatment), treatment regimens, prevention and management of complications, criteria for conversion surgery, and postoperative intraperitoneal therapy. The consensus aims to standardize clinical practice and improve the prognosis of patients with GCPM.

Peritoneal metastasis of gastric cancer is a common metastatic form in advanced gastric cancer, and conventional systemic chemotherapy has shown unsatisfactory efficacy. This article systematically examines the clinical value and implementation strategies of normothermic intraperitoneal chemotherapy and systemic therapy (NIPS) in the treatment of gastric cancer peritoneal metastasis. It covers aspects such as the precise selection of treatment candidates, optimization of drug regimens, standardized management of intraperitoneal chemotherapy ports, determination of the appropriate timing for conversion surgery, and postoperative treatment optimization. The aim is to provide scientific guidance for the clinical application of NIPS, promote its standardization, and improve the prognosis for patients with gastric cancer peritoneal metastasis.

Once peritoneal metastasis occurs, the prognosis of gastric cancer is extremely poor, and the median survival time is only about 6-9 months. In recent years, the clinical research on peritoneal metastasis of gastric cancer has become a hot spot. Based on the research results at home and abroad, the author put forward several important measures, which will contribute to further improve the curative effect of gastric cancer with peritoneal metastasis. (1) Improving the preoperative diagnostic rate of peritoneal metastasis is a prerequisite factor; (2) actively preventing peritoneal metastasis is the priority strategy; (3) combining systemic and intraperitoneal therapy is the key mode. (4) performing radical conversion surgery is the fundamental means. In this paper, the above important issues are discussed to communicate with colleagues.

Objective:To evaluate the clinical value and safety of an intraperitoneal chemotherapy port technique in patients with gastric cancer and peritoneal metastases undergoing intraperitoneal chemotherapy.Methods:This was a retrospective, descriptive case analysis. From November 2022 to October 2024, patients diagnosed with gastric cancer and peritoneal metastases at Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine with an expected survival >3 months, underwent laparoscopic exploration combined with implantation of an intraperitoneal chemotherapy port [PORT-A-CATH II system (Model 21-4055-24)] implantation. The procedure was as follows: (1) after laparoscopic exploration, a 4-cm skin incision was made at a predetermined site and a subcutaneous pocket created by dissecting to the muscle fascia and removing subcutaneous fat as needed to position the port septum 0.5-1.0 cm from the skin surface; (2) under direct laparoscopic visualization, the abdominal cavity was punctured and a guidewire inserted, followed by an 8.5 Fr sheath, through which a catheter with three trimmed side holes was placed after removal of the sheath; (3) the catheter length in the abdominal cavity was adjusted to 25–30 cm and the catheter trimmed, and connected to the port base, ensuring it extended beyond the connector's visible hole; (4) the whole port was placed within the subcutaneous pocket, and non-absorbable sutures used to create a double purse-string suture at the catheter's abdominal entry, forming an anti-reflux ring; (5) non-absorbable sutures were used to securely fix the port to the fascia through its four base holes and the exposed catheter segments on the fascia sutured and buried; (6) patency was confirmed by injecting saline and followed by intermittent skin closure provided there was no bleeding; and (7) the catheter tip was positioned in the pelvic cavity under laparoscopic guidance. Postoperatively, the patients underwent normothermic intraperitoneal and systemic treatment. The port infusion protocol involved disinfecting the skin (>10 cm diameter) around the port, confirming the puncture site, inserting a Huber needle vertically at 90° to the port base, infusing 100 mL saline to ensure patency, followed by continuous infusion of 1000 mL paclitaxel solution, and sealing with 20 mL saline before removing the needle. No saline flushing was required between chemotherapy infusions. The primary outcomes were the incidence and management of complications post-port implantation.Results:The study cohort comprised 225 patients with gastric cancer and peritoneal metastases. Using standardized port implantation and postoperative puncture procedures, the complication rate during follow-up was 14.2% (32/225), including effusion in 14 patients (6.2%), port infection in 10 (4.4%), incision dehiscence in four (1.8%), port inversion in two (0.9%), hematoma in one (0.4%), and catheter rupture in one (0.4%). Seventy-five percent (24/32) of patients with complications recovered and continued using the port after conservative treatments (e. g., aspiration of effusions, antibiotic therapy, incision management), whereas the remaining 25.0% (8/32) with complications required surgical removal of the port because the treatment was ineffective. The presence of preoperative ascites ( P=0.019) and peritoneal cancer index score>15 ( P=0.038) were significantly associated with development of complications. Conclusions:Our standardized procedure for intraperitoneal chemotherapy port implantation is safe and feasible for patients with gastric cancer and peritoneal metastases, having a low overall complication rate. Most complications can be successfully managed with conservative treatment, the device thus providing reliable support for intraperitoneal chemotherapy.

Peritoneal metastasis of gastric cancer is a common metastatic form in advanced gastric cancer, and conventional systemic chemotherapy has shown unsatisfactory efficacy. This article systematically examines the clinical value and implementation strategies of normothermic intraperitoneal chemotherapy and systemic therapy (NIPS) in the treatment of gastric cancer peritoneal metastasis. It covers aspects such as the precise selection of treatment candidates, optimization of drug regimens, standardized management of intraperitoneal chemotherapy ports, determination of the appropriate timing for conversion surgery, and postoperative treatment optimization. The aim is to provide scientific guidance for the clinical application of NIPS, promote its standardization, and improve the prognosis for patients with gastric cancer peritoneal metastasis.

Once peritoneal metastasis occurs, the prognosis of gastric cancer is extremely poor, and the median survival time is only about 6-9 months. In recent years, the clinical research on peritoneal metastasis of gastric cancer has become a hot spot. Based on the research results at home and abroad, the author put forward several important measures, which will contribute to further improve the curative effect of gastric cancer with peritoneal metastasis. (1) Improving the preoperative diagnostic rate of peritoneal metastasis is a prerequisite factor; (2) actively preventing peritoneal metastasis is the priority strategy; (3) combining systemic and intraperitoneal therapy is the key mode. (4) performing radical conversion surgery is the fundamental means. In this paper, the above important issues are discussed to communicate with colleagues.

Objective:To evaluate the clinical value and safety of an intraperitoneal chemotherapy port technique in patients with gastric cancer and peritoneal metastases undergoing intraperitoneal chemotherapy.Methods:This was a retrospective, descriptive case analysis. From November 2022 to October 2024, patients diagnosed with gastric cancer and peritoneal metastases at Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine with an expected survival >3 months, underwent laparoscopic exploration combined with implantation of an intraperitoneal chemotherapy port [PORT-A-CATH II system (Model 21-4055-24)] implantation. The procedure was as follows: (1) after laparoscopic exploration, a 4-cm skin incision was made at a predetermined site and a subcutaneous pocket created by dissecting to the muscle fascia and removing subcutaneous fat as needed to position the port septum 0.5-1.0 cm from the skin surface; (2) under direct laparoscopic visualization, the abdominal cavity was punctured and a guidewire inserted, followed by an 8.5 Fr sheath, through which a catheter with three trimmed side holes was placed after removal of the sheath; (3) the catheter length in the abdominal cavity was adjusted to 25–30 cm and the catheter trimmed, and connected to the port base, ensuring it extended beyond the connector's visible hole; (4) the whole port was placed within the subcutaneous pocket, and non-absorbable sutures used to create a double purse-string suture at the catheter's abdominal entry, forming an anti-reflux ring; (5) non-absorbable sutures were used to securely fix the port to the fascia through its four base holes and the exposed catheter segments on the fascia sutured and buried; (6) patency was confirmed by injecting saline and followed by intermittent skin closure provided there was no bleeding; and (7) the catheter tip was positioned in the pelvic cavity under laparoscopic guidance. Postoperatively, the patients underwent normothermic intraperitoneal and systemic treatment. The port infusion protocol involved disinfecting the skin (>10 cm diameter) around the port, confirming the puncture site, inserting a Huber needle vertically at 90° to the port base, infusing 100 mL saline to ensure patency, followed by continuous infusion of 1000 mL paclitaxel solution, and sealing with 20 mL saline before removing the needle. No saline flushing was required between chemotherapy infusions. The primary outcomes were the incidence and management of complications post-port implantation.Results:The study cohort comprised 225 patients with gastric cancer and peritoneal metastases. Using standardized port implantation and postoperative puncture procedures, the complication rate during follow-up was 14.2% (32/225), including effusion in 14 patients (6.2%), port infection in 10 (4.4%), incision dehiscence in four (1.8%), port inversion in two (0.9%), hematoma in one (0.4%), and catheter rupture in one (0.4%). Seventy-five percent (24/32) of patients with complications recovered and continued using the port after conservative treatments (e. g., aspiration of effusions, antibiotic therapy, incision management), whereas the remaining 25.0% (8/32) with complications required surgical removal of the port because the treatment was ineffective. The presence of preoperative ascites ( P=0.019) and peritoneal cancer index score>15 ( P=0.038) were significantly associated with development of complications. Conclusions:Our standardized procedure for intraperitoneal chemotherapy port implantation is safe and feasible for patients with gastric cancer and peritoneal metastases, having a low overall complication rate. Most complications can be successfully managed with conservative treatment, the device thus providing reliable support for intraperitoneal chemotherapy.

The combination of anti-angiogenesis,immune checkpoint inhibitors(ICIs)and chemotherapy(target-immune-chemo)has achieved initial results in the comprehensive treatment of gastric cancer.Experimental studies have shown that among various determinants of tumor immunotherapy,tumor microenvironment(TME)plays a crucial role in affecting ICIs efficacy.The biological mechanism leading to immunosuppressive TME is multi-factorial and very complex,but one of clear and important mechanisms is the influence of abnormal neoangiogenesis in tumors.The use of low-dose targeted tumor angiogenesis drugs(such as anti-VEGF/VEGFR monoclonal antibody,etc.)is expected to make tumor vessels normalization and reverse immunosuppressive TME to immunesupportive TME,so as to play synergistic,complementary,anti-tumor effects with ICIs and chemotherapy drugs.Perioperative treatment of locally advanced gastric cancer(LAGC)has become an indispensable and important strategy in surgical comprehensive treatment of gastric cancer.In recent years,a therapeutic combination regimen of anti-angiogenesis,ICIs and chemotherapy(target-immune-chemo)has been clinically applied in the perioperative treatment of LAGC,and the preliminary efficacy[pathologic complete response(pCR),major pathological response(MPR),tumor regression grade(TRG)and treatment-related adverse events(TRAEs),etc.]has shown encouraging results.This article reviewed the relevant clinical research results and made a summary and analysis.

The clinical application of immune checkpoint inhibitor (ICI) offers novel treatment modality for locally advanced gastric cancer (LAGC) and adenocarcinoma of the gastroesophageal junction (AGEJ), with the crucial benefit of providing higher cure rates. These agents have become part of standard treatments in the perioperative setting for selected cases, such as tumor with MSI-H/dMMR, high expression of CPS (≥5) or EBV (+), MSI-H and MSS/TP53+ according to tumor immunohistochemical, genetic testing or molecular characterization. An in-depth understanding of the immune response mechanisms in "cold" and "hot" tumors enables us to better identify ICI beneficiary and further provide a rationale for converting nonresponsive "cold" tumors into responsive "hot" tumors, subsequently allowing nonresponders to benefit from ICI immunotherapy. Several recent clinical trials clearly demonstrated a synergistic and complementary effect of combining ICI with chemotherapy or chemoradiotherapy, as well as combining ICI with anti-HER2 or anti-VEGF/VEGFR and chemotherapy. Compared with chemotherapy alone, the combination treatment can significantly improve pCR, MRR or ypT0N0, and is expected to improve the prognosis. This article reviews the results of a series of clinical trials in recent years in the field of perioperative application of ICI with other modalities in LAGC/AGEJ, aiming at expanding upon the discussion of current standard neoadjuvant and adjuvant therapies for LAGC/AGEJ and exploring the feasibility of new perioperative combined immunotherapy in the future.