{'fraction_non_alphanumeric': 0.025552187093980078, 'fraction_numerical': 0.0038977912516240795, 'mean_word_length': 5.774193548387097, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Cytoreductive surgery and hyperthermic intra‐peritoneal chemotherapy (HIPEC) for gastric adenocarcinoma: Why haven't we reached the promised land?

Gastric adenocarcinoma (gastric cancer, GC) is the fourth most common cancer and the second leading cause of cancer death worldwide. There are major differences in the incidence of GC across countries and continents. Global incidence, as well as primary tumor location and histological type are constantly changing. In the US and most of Western Europe, there has been a marked decline in distal, intestinal type GC, while the incidence of proximal and Barrett’s type adenocarcinoma of the gastric cardia and esophago-gastric junction has been increasing. The incidence of diffuse type adenocarcinoma, on the other hand, is largely unchanged [1]. Adenocarcinoma of the body and antrum predominates in developing countries, among AfricanAmericans, and in lower socio-economic groups, whereas proximal tumors are more common in developed countries, among Caucasians, and in higher socio-economic classes. The main risk factors for adenocarcinoma of the body and antrum include Helicobacter pylori infection and predisposing dietary factors, whereas gastroesophageal reflux disease and obesity play important roles in the development of proximal stomach cancer. The current treatment paradigm includes surgical resection with D1þ or D2 lymphadenectomy for non-metastatic GC, and palliative systemic therapy for disseminated tumors. In patients with locally advanced GC demonstrating serosal invasion, lymph node metastasis or positive peritoneal washing cytology, the prognosis following surgical therapy alone is poor. In an attempt to improve survival, various innovative therapeutic approaches have been studied. In the US, the Intergroup 0116 study showed a survival advantage for postoperative combined modality using chemoradiation [2]. Despite the lack of surgical quality assurance, resulting in poor quality surgery for most patients participating in the trial, this approach is now widely adopted throughout Northern America. A different approach was studied in Europe in large prospective randomized clinical trials. In the MAGIC trial conducted by the Medical Research Council in the UK, chemotherapy [Epirubicin, Cisplatin, and 5-Fluourouracil (ECF)],