Comparative Study of the Efficacy and Safety of Radical Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy in Locally Advanced Gastric Cancer: A Propensity Score-Matching Analysis.

Abstract

The effectiveness and safety of preventive hyperthermic intraperitoneal chemotherapy (HIPEC) for gastric cancer (GC) remain controversial. This study aimed to describe the safety and efficacy of radical surgery (RS) with or without HIPEC for patients with locally advanced GC (LAGC). The study identified 394 patients with LAGC who underwent RS with or without HIPEC in China. Of the 394 patients, 146 received RS+HIPEC, and 248 received RS alone. The RS-HIPEC procedure improved the relapse-free survival (RFS) of the GC patients (2-year RFS, 62.9 % vs 37.8 %; χ2 = 4.468; P = 0.035) compared with those who received RS alone. The incidence of postoperative myelosuppression (Z = 4.077; P = 0.043) was higher in the RS+HIPEC group, whereas the incidence of wound complications was lower (Z = 4.077; P = 0.043). In the subgroup analysis, HIPEC improved the OS (2-year OS, 69.9 % vs 40.8 %; χ2 = 5.537; P =0.019) and RFS (2-year RFS, 65.6 % vs 33.3 %; χ2 = 7.380, P = 0.007) of the patients with nerve invasion and the RFS of the patients with vascular invasion (2-year RFS, 60.7 % vs 31.6 %; χ2 = 3.891; P = 0.049). In addition, the prognosis of the patients who underwent HIPEC was better when the tumor diameter was smaller than 5 cm (2-year RFS, 68.6 % vs 37.9 %; χ2 = 3.957; P = 0.047). The RS + HIPEC procedure improved the RFS of the patients with LAGC compared with RS alone, especially the patients with nerve or vascular invasion and the patients with tumor smaller than 5 cm. Moreover, it reduced the incidence of wound complications and did not induce more perioperative complications in addition to myelosuppression.