关键词: 胃癌, 不可切除, 转化治疗, 细胞减灭术, 腹腔热灌注化疗

Abstract:

Treatment strategy for unresectable local advanced gastric cancer from a surgical point of view        LIANG Han. Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Institute & Hospital，National Clinical Research Center for Cancer，Tianjin 300060，China
Abstract    According to Yoshida’s stage IV gastric cancer classification, for some patients with marginally resectable and potentially unresectable metastatic gastric cancer，neoadjuvant intraperitoneal plus systematic chemotherapy (NIPS)，cytoreductive surgery（CRS） plus hyperthermic intraperitoneal chemotherapy (HIPEC)，palliative surgery plus chemotherapy，conversion therapy with docetaxel based three drug regimen and S1/paclitaxel chemotherapy plus apatinib may be benefited. For patients with moderate amount and more ascites，NIPS regimen may control the ascites, relieve symptoms and prolong the survival time. CRS+HIPEC has been demonstrated to provide survival benefit for patients with PCI  (peritoneal cancer index) score≤6. It is still controvertial whether the palliative surgery followed by chemotherapy may benefit for patient or not，but judicious use of surgical resection both gastrectomy and metastasis before chemotherapy in metastatic gastric cancer patients may result in favorable treatment approach. Conversion therapy with docetaxel based three drug regimen and chemotherapy combined with apatinib may result a high conversion rate.

Key words: gastric cancer, unresectable, conversion therapy, cytoreductive surgery (CRS), hyperthermia intraperitoneal chemotherapy( HIPEC)