Research progress in clinical trials of pressurized intraperitoneal aerosol chemotherapy for advanced gastric cancer with peritoneal metastasis

Abstract Peritoneal metastasis is a common form of metastasis in advanced gastric cancer, often associated with poor prognosis. The distinctive biological characteristics of peritoneal metastasis have resulted in the limited efficacy of conventional treatments, including systemic chemotherapy and cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC). Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel intraperitoneal drug delivery method administered via laparoscopy, offering several advantages, including a lower drug dosage, a more extensive and uniform drug distribution, and deeper drug penetration compared to HIPEC. As an innovative treatment for advanced gastric cancer with peritoneal metastases, PIPAC has attached increasing attention from researchers globally. A significant number of research centers around the globe are currently engaged in investigating this technique. In this study, a comprehensive review of prospective studies on PIPAC for advanced gastric cancer with peritoneal metastasis, conducted since 2012, is presented. This review includes four completed studies and seven ongoing studies. Published results demonstrate promising feasibility, safety, and efficacy for PIPAC. However, further large-scale, prospective, randomized controlled clinical trials are necessary to compare treatment regimens and fully establish the safety and short- and long-term efficacy of PIPAC. Additionally, future studies should further clarify the indications and contraindications for PIPAC in treating advanced gastric cancer with peritoneal metastasis.