J Gastric Cancer.  2018 Sep;18(3):296-304. 10.5230/jgc.2018.18.e32.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy as Treatment Options for Peritoneal Metastasis of Advanced Gastric Cancer

• Kim DW
• Park DG
• Song S
• Jee YS

• KMID: 2420789
• DOI: http://doi.org/10.5230/jgc.2018.18.e32

Abstract

PURPOSE
This study aimed to examine the outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastasis (PM) of advanced gastric cancer (AGC).
MATERIALS AND METHODS
Between May 2015 and June 2017, 38 CRS and HIPEC procedures were performed in patients with PM of AGC at the Dankook University Hospital. We prospectively collected and analyzed data regarding PM grade, morbidity and mortality rates, and short-term follow-up results (median, 13.5 months).
RESULTS
The mean peritoneal cancer index was 15 (range, 0-39). Complete cytoreduction was achieved in 21 patients (55.2%), whereas complications occurred in 16 (42.1%) and 2 (5.7%) patients died. The overall median patient survival time was 19 months. The patients who underwent complete cytoreduction had a median survival time of 26 months, which was significantly longer than the median survival time of 16 months in the patients who did not undergo complete cytoreduction (P=0.006).
CONCLUSIONS
CRS with HIPEC may have a beneficial effect in patients with PM of AGC. However, the rates of complications and mortality associated with this combined therapeutic approach are high. Therefore, this treatment should be performed only in selected patients by surgeons experienced in the field of gastric cancer with PM.

Keyword

Cytoreductive surgery; Hyperthermic intraperitoneal chemotherapy; Gastric cancer

MeSH Terms

Drug Therapy*
Follow-Up Studies
Humans
Mortality
Neoplasm Metastasis*
Prospective Studies
Stomach Neoplasms*
Surgeons

Figure

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  Fig. 1 Operative findings in cytoreductive surgery. (A) Parietal peritonectomy and (B) specimen of the resected organ.

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  Fig. 2 Median survival time according to the peritoneal cancer index (PCI; grade I, 26 months; grade II, 16 months; and grade III, 12 months; P=0.041). PCI = peritoneal cancer index.

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  Fig. 3 Median survival time according to the CCR (CCR 0/1, 26 months and CCR 2/3, 16 months; P=0.006). CCR = completeness of cytoreduction.

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