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

Inclusion criteria * Gastric or Gastroesophageal junction Siewert type III adenocarcinomas * Clinical T3-4a-stages 1. Any differentiation grade 2. Any histological subtype * Clinical T2-stage a. 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. Exclusion criteria * Previous allergic reaction to cisplatin, doxorubicin or other platinum-containing compounds. * Renal impairment, defined as glomerular filtration rate (GFR) \< 40 ml/min (Cockcroft-Gault Equation). * Myocardial insufficiency, defined as New York Heart Association (NYHA) class 3-4. * 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. * Any other condition or therapy which, in the investigator's opinion, may pose a risk to the patient or interfere with the study objectives.