Selection Criteria and Prognostic Factors for Cytoreductive Surgery (CRS) plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Gastric Cancer with Peritoneal Metastases: A Systematic Review

Abstract

Peritoneal dissemination of gastric adenocarcinoma imposes a phenotype highly resistant to conventional systemic regimens. Following the PRISMA 2020 guidelines and the PROSPERO protocol (CRD420261412861), a critical review was conducted to elucidate eligibility criteria and prognostic determinants in adults undergoing cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). The search algorithm encompassed eight global repositories (MEDLINE, Embase, Scopus, among others). From an initial pool of 256 records, 14 articles were selected as eligible for qualitative synthesis. Optimization of oncological and perioperative outcomes is not a homogeneous variable; it depends on a restrictive biological profile of both the host and the tumor. This scenario requires the coexistence of a low tumor burden (low Peritoneal Cancer Index), exclusion of extraperitoneal foci, optimal functional status, and demonstrated chemosensitivity. Operationally, the technical feasibility of achieving complete cytoreduction (CC-0/CC-1) solidified the most robust surgical predictor of overall survival. Consequently, the CRS + HIPEC protocol demands strict clinical governance. Far from becoming a universally applicable therapeutic standard, it constitutes a salvage alternative directed exclusively at meticulously staged molecular and clinical subgroups.