Prophylactic Surgery Plus HIPEC With CO2 in Patients Affected by Gastric Carcinoma.GOETH Study

Inclusion Criteria: 1. Patients with histologically documented gastric carcinoma (diffuse/intestinal histotype) eligibile for R0. 1. Presurgical or intraoperative stage T3-T4 N0-N+ primary tumour (TNM 8 th). 2. Urgent presentation: perforation without purulent generalized peritonitis 3. Positive cytology of peritoneal fluid (if previously obtained) 2. Age ≥ 18 years and ≤75 years. 3. Written informed consent. Exclusion Criteria: 1. Gastroesophageal Junction (GEJ) cancer 2. Distant metastatic disease (even if limited and completely resected) 3. Peritoneal carcinomatosis 4. History of tumor diagnosed in the 3 years before entering the study, except for topical and healed pathologies that do not need further treatment (e.g. non-melanoma skin carcinomas, superficial bladder carcinomas or in situ carcinoma of the breast or cervix). 5. Psychological, family or social conditions which may negatively affect the treatment and follow-up protocol. 6. Poor general conditions (ECOG \> 2). 7. Impaired cardiac function (history of congestive heart failure or FE \<40%). Clinically significant cardiovascular disease: cerebral vascular accident/stroke (\< 6 months prior to enrolment), unstable angina, congestive heart failure (New York Heart Association Classification Class \> II) or serious uncontrolled cardiac Arrhythmia requiring medication 8. Impaired renal function (creatinine\> 1.5 upper limit of normal or creatinine clearance \<60 mL / min). 9. Impaired hepatic function (AST, ALT \>2.5 upper limit of normal, bilirubin \> 1.5 upper limit of normal). 10. Impaired hematopoietic function (leucocytes \<4000 / mm3, neutrophils \<1500 / mm 3, platelets \<100000 / mm3). 11. Impaired pulmonary function (presence of COPD or other pulmonary restrictive conditions with FEV1 \<50% or DLCO \<40% of normal age value). 12. History or presence of other disease, metabolic dysfunction, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates use of HIPEC or chemotherapy or patient at high risk from treatment complications. 13. Pregnancy. 14. Krukenberg tumor 15. Refusal to join the study.