Conversion Surgery for Patients with Advanced Gastric Cancer with Peritoneal Carcinomatosis

Abstract

Background. Patients with advanced gastric cancer (AGC) with peritoneal carcinomatosis (PC) usually have poor outcomes and high mortality risk, even with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This study analyzed the prognostic factors of AGC with PC and evaluated laparoscopic HIPEC (LHIPEC) plus neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) as a conversion surgery for AGC patients with PC with a poor initial prognosis. Patient and Methods. We retrospectively evaluated 127 patients with AGC and PC from January 1, 2012, to March 1, 2020. After the exclusion of 32 ineligible patients, the conversion group comprised 34 patients who underwent LHIPEC + NIPS as a conversion surgery followed by CRS plus HIPEC. The CRS + HIPEC group included 15 patients who underwent CRS with HIPEC alone. Additionally, the C/T group comprised 23 patients who received systemic chemotherapy, and the palliative group comprised 23 patients who received only conservative therapy or palliative gastrectomy. Results. The conversion group demonstrated a significantly better mean overall survival compared to the CRS + HIPEC, C/T, and palliative groups ( p < 0.001 ). Patients in the conversion group who underwent LHIPEC + NIPS had significantly decreased peritoneal cancer index (PCI) scores ( p < 0.001 ) and ascites ( p = 0.003 ). Malignant ascites amount also significantly decreased after treatment in the LHIPEC + NIPS group ( p < 0.001 ). Conclusions. LHIPEC + NIPS can significantly improve the overall survival, the PCI score, and malignant ascites amount in peritoneal cytology-positive gastric cancer with PC, and an initially high PCI score. Therefore, it may be a feasible conversion strategy for AGC patients with PC.

Hyperthermic intraperitoneal chemotherapy for patients with gastric cancer based on laboratory tests is safe: a single Chinese center analysis

“…Although the impact of HIPEC on prognosis was not observed in our study, HIPEC still plays an irreplaceable role in patients with gastric cancer. A study in China showed that HIPEC signi cantly improved the OS and treatment of malignant ascites in patients with gastric cancer with initially higher PCI scores and positive peritoneal lavage uid with peritoneal metastasis (P < 0.001) [5]. This was also con rmed by a multicenter study in Spain [6,7].…”

“…Although HIPEC is frequently used in the treatment of peritoneal metastases from abdominal malignancies, such as gastric cancer [4], HIPEC has an irreplaceable role in patients with malignant ascites. A study in China showed that HIPEC signi cantly improved the overall survival (OS) and treatment of malignant ascites in patients with gastric cancer with initially high peritoneal carcinoma index (PCI) scores and positive peritoneal lavage uid with peritoneal metastasis (P < 0.001) [5]. This result was con rmed by multicenter studies in Spain [6,7].…”

Hyperthermic intraperitoneal chemotherapy for patients with gastric cancer based on laboratory tests is safe: a single Chinese center analysis

“…Although the impact of HIPEC on prognosis was not observed in our study, HIPEC still plays an irreplaceable role in patients with gastric cancer. A study in China showed that HIPEC significantly improved the OS and treatment of malignant ascites in patients with gastric cancer with initially higher PCI scores and positive peritoneal lavage fluid with peritoneal metastasis ( P < 0.001) [ 5 ]. This was also confirmed by a multicenter study in Spain [ 6 , 7 ].…”

“…Although HIPEC is frequently used in the treatment of peritoneal metastases from abdominal malignancies, such as gastric cancer [ 4 ], HIPEC has an irreplaceable role in patients with malignant ascites. A study in China showed that HIPEC significantly improved the overall survival (OS) and treatment of malignant ascites in patients with gastric cancer with initially high peritoneal carcinoma index (PCI) scores and positive peritoneal lavage fluid with peritoneal metastasis ( P < 0.001) [ 5 ]. This result was confirmed by multicenter studies in Spain [ 6 , 7 ].…”

Consensus Guideline for the Management of Gastric Cancer with Synchronous Peritoneal Metastases

“…59 Lee et al found that patients who underwent L-HIPEC + NIPS followed by CRS-HIPEC had a better mean overall survival compared to those who only underwent CRS-HIPEC, chemotherapy or palliative care. 60 Laparoscopic HIPEC (L-HIPEC) Given the high morbidity associated with combining HIPEC and CRS, there has been an effort to administer HIPEC in a minimally invasive fashion, so as to decrease the associated morbidity. First published by Yonemura in 2016, other groups have shown that L-HIPEC was well tolerated and could reduce PCI score.…”