u/Dear-Description8719

A 28-year-old woman has gastric signet-ring cell carcinoma with confirmed peritoneal metastasis. She completed 12 cycles of FLOT + immunotherapy, and her latest PET/CT shows a complete metabolic response with disappearance of the previously active disease.
Her doctor does not recommend gastrectomy/CRS + HIPEC, mainly because of the signet-ring histology and because he considers this outside standard protocol. He is willing to review published evidence.
Can anyone share peer-reviewed studies, case series, expert surgeon opinions, conference talks, or major centers that have treated signet-ring gastric cancer + peritoneal metastasis with surgery/CRS + HIPEC, especially after a strong response to systemic therapy?
I understand this is not standard for every patient. I am specifically trying to determine whether signet-ring histology itself should be considered an absolute contraindication.

We have a 28-year-old female diagnosed with signet ring cell gastric cancer with peritoneal metastasis.
She has now completed 9 cycles of FLOT chemotherapy and 5 cycles of immunotherapy, and she is currently being evaluated for the next step in treatment.
Has anyone had a similar experience, especially with signet ring cell gastric cancer and peritoneal metastasis? Any advice, personal experiences, or recommendations would be greatly appreciated.
Thank you in advance.