Patient description: The patient is a 41-year-old obese woman coming to the emergency room with abdominal pain and vomiting. The pain that started gradually yesterday is located in the epigastric and periumbilical regions, radiating to her back. She drinks alcohol frequently and does not smoke. She has no history of allergies and uses only multivitamins daily. Her family history is positive for hypertension (her mother). She lives with her husband and has 3 children. The abdomen is tender and soft. Her bowel sounds are normal. Her heart rate is 115/min and blood pressure 110/75 mmHg. The lab studies are remarkable for leukocytosis (19.5), urea of 8.5, high CRP (145), high amylase (1200) and Glucose level of 15. Her abdominal CT scan revealed acute edematous interstitial pancreatitis with enlarged common bile duct and intrahepatic duct confirming gall stone pancreatitis. Her pregnancy test is negative and she is not breastfeeding.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Gastric Adenocarcinoma Esophagogastric Junction Gastric Cancer Patients must have histologically or cytologically confirmed gastric adenocarcinoma or gastroesophageal junction (Siewert I-III) adenocarcinoma confirmed by the Laboratory of Pathology, NCI Must have received systemic chemotherapy, minimum 3 months or maximum 6 months, prior to enrollment Systemic therapy should consist of at least fluoropyrimidine-based and/or platinum based chemotherapy Trastuzumab may be added for HER2-neu over-expressing cancers as clinically indicated Last dose of chemotherapy within 8 weeks of enrollment with recovery to Grade 1 from chemotherapy-related toxicities Documentation of chemotherapy administration must be obtained Subradiographic and/or cytopathologic evidence of peritoneal carcinomatosis found at staging laparoscopy Documentation of cytopathologic diagnosis of malignant peritoneal cytology in the absence of disseminated peritoneal disease must be obtained. If cytologic analysis reveals atypical cells of undetermined significance, a repeat lavage with cytopathologic analysis will be performed and must demonstrate evidence of malignancy Limited peritoneal involvement found at staging laparoscopy or on final pathology that is deemed completely resectable is permitted Age >18 years  Patients who are receiving any investigational agents Disseminated extra-peritoneal or solid organ metastases Includes carcinomatosis associated with clinically or radiographically evident ascites (greater than 500cc) --Excludes greater omentum and ovarian metastases Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements Pregnant women are excluded from this study because HIPEC and gastrectomy have not been studied in pregnant women and has the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with HIPEC and gastrectomy, breastfeeding should be discontinued if the mother is treated on this study HIV-positive patients may be considered for this study only after consultation with a NIAID physician