The Efficacy of PIPAC and Minimally Invasive Radical Resection in High-risk Gastric Cancer Patients.

Prior treatment

• Previous allergic reaction to cisplatin, doxorubicin or other platinum-containing compounds.

Other illness

• Myocardial insufficiency, defined as New York Heart Association (NYHA) class 3-4.
• Any other condition or therapy which, in the investigator's opinion, may pose a risk to the patient or interfere with the study objectives.

Lab values

• Renal impairment, defined as glomerular filtration rate (GFR) \< 40 ml/min (Cockcroft-Gault Equation).
• An impaired liver function, defined as bilirubin ≥ 1.5 x upper normal limit (UNL).
• An inadequate haematological function, defined as absolute neutrophil count (ANC) \<1.5 x 109/l and platelets \<100 x 109/l.

• Gastric or Gastroesophageal junction Siewert type III adenocarcinomas
• Clinical T3-4a-stages
  • Any differentiation grade
  • Any histological subtype
• Clinical T2-stage
  • If poorly differentiated or of the poorly cohesive histological subtype, with or without the presence of signet-ring cells
• Any clinical T-stage with positivity for malignant cells on abdominal lavage cytology, which is converted to cytology negative in response to neoadjuvant chemotherapy.
• Any clinical nodal-stage
• clinical M0-stage (positive abdominal wash cytology, which is converted to cytology negative in response to neoadjuvant therapy, is permitted)
• Performance status Eastern Cooperative Oncology Group (ECOG) 0-1
• Age 18 - 80 years
• Undergoing robotic or laparoscopic D2 gastrectomy
• Able and willing to provide written informed consent and to comply with the clinical study protocol
• Fertile women must have a negative pregnancy test at the time of inclusion and must use adequate contraception.