Abstract
Relevance: Peritoneal carcinomatosis is one of the most unfavorable patterns of gastric cancer progression and is associated with poor overall survival, limited efficacy of systemic chemotherapy, and a high risk of refractory ascites. Multimodal approaches, including intraperitoneal chemotherapy, CRS+HIPEC, and PIPAC, are increasingly being considered for selected patients.The study aimed to summarize current evidence on the pathogenesis, diagnosis, and treatment of peritoneal carcinomatosis in gastric cancer, with emphasis on the outcomes of different mono- and combination treatment regimens.Materials and Methods: A systematic literature search was conducted in PubMed, Google Scholar, eLibrary, and CyberLeninka. Full-text articles published in Russian and English between 2020 and 2025 were included. The selection of publications was performed in accordance with the PRISMA 2020 recommendations.Results: Peritoneal dissemination is detected in 20-35% of patients at initial diagnosis and may reach 50-60% during disease progression. Median overall survival with standard systemic chemotherapy is approximately 8-12 months. Combined regimens may increase survival to 12-14.4 months, while bidirectional therapy with intraperitoneal paclitaxel demonstrates a median survival of about 14.6 months. In carefully selected patients with limited peritoneal involvement, CRS+HIPEC may achieve a median survival of 18.8-20.2 months or longer.Conclusion: Current evidence indicates a shift from an exclusively palliative approach toward personalized multimodal treatment of peritoneal carcinomatosis in gastric cancer. Promising directions include early detection of occult peritoneal dissemination, patient stratification based on the PCI score, molecular genetic profiling, and the rational combination of systemic therapy with locoregional intraperitoneal treatment modalities.