Perioperative Intraperitoneal Paclitaxel for the Treatment of Stage IV Gastric or Gastroesophageal Adenocarcinoma with Carcinomatosis or Positive Cytology

Inclusion Criteria

• Age 18 years and above. There will be no upper age restriction. Because no dosing or adverse event data are currently available on the use of intraperitoneal paclitaxel in patients < 18 years of age, children are excluded from this study
• Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
• Cytologic or histologic proof of adenocarcinoma of the stomach or gastroesophageal junction
• Leukocytes >= 3,000/uL
• Absolute neutrophil count >= 1,500/uL
• Platelets >= 60,000/Ul
• Serum creatinine =< 1.6 mg/dL
• Distant metastatic disease of peritoneum: * Positive peritoneal cytology, or * Carcinomatosis on diagnostic laparoscopy or laparotomy
• Completion of preoperative systemic cytotoxic chemotherapy. Targeted therapy, such as HER2 directed therapy, and immunotherapy, such as PD-1 inhibitors, may be continued
• English and non-English speaking patients are eligible

Exclusion Criteria

• Distant metastatic disease not limited to the peritoneum such as solid organ metastases to the liver, central nervous system, or lung
• Infections such as pneumonia or wound infections that would preclude protocol therapy
• Women with a positive urine or serum pregnancy test are excluded from this study; women of childbearing potential (defined as those who are not postmenopausal defined as no menses in greater than or equal to 12 months, have not had a hysterectomy or bilateral salpingo-oophorectomy, do not have ovarian failure, or have not had a surgical sterilization procedure) must agree to refrain from breast-feeding and practice adequate contraception as specified in the informed consent. Adequate contraception consists of oral contraceptive, implantable contraceptives, injectable contraceptives, a double barrier method, or abstinence. Men with reproductive potential must agree to an appropriate method of birth control, including abstinence or double barrier method (diaphragm plus condom)
• Subjects with unstable angina or New York Heart Association grade II or greater congestive heart failure
• Subjects, such as those with cognitive impairment, deemed unable to comply with study and/or follow-up procedures
• Subjects with a known hypersensitivity to protocol systemic chemotherapy that was life-threatening, required hospitalization or prolongation of existing hospitalization, or resulted in persistent or significant disability or incapacity
• Previous surgery that would preclude safe cytoreduction and intraperitoneal port placement