Abstract
Peritoneal metastases (PM) of gastric cancer (GC) are characterized by a particularly poor prognosis, with median survival time of 6 months, and virtually no 5-year survival reported. Conversion therapy for GC is defined as a surgical treatment aiming at an R0 resection after systemic chemotherapy for tumours that were originally unresectable (or marginally resectable) for technical and/or oncological reasons. The aim of the present study was to evaluate early and late outcomes in GC patients with PM who underwent the cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) after neoadjuvant (conversion) chemotherapy. Thirty patients with stage IV GC underwent CRS plus HIPEC. Severe grade III/IV (Clavien-Dindo classification) complications occurred in 13 (43%) patients. The Comprehensive Complication Index (CCI) ranged from 8.7 to 100 (median, 42.4). In the multivariate survival analysis, ypT2 and P3 (according to the Japanese classification of the PM severity) were favourable and adverse prognostic factors p = 0.031 and o = 0.035, respectively. Estimated 1- and 3-year survival was 73.9% and 36.6%, respectively. The median survival was 19.3 months. Conclusion: Conversion surgery, including extended gastrectomy and multi-organ resections followed by HIPEC performed after systemic chemotherapy therapy for GC with PM is justified in downstaged patients with ypT2 and limited (less than P3) PM.
Highlights
The problem of synchronous peritoneal metastases (PM) in gastric cancer (GC) affects about 5% to30% of patients, whereas the incidence of peritoneal relapse is 46% to 54% [1,2]
Conversion therapy for GC is defined as a surgical treatment aiming at an R0 resection after systemic chemotherapy for tumours that were originally unresectable for technical and/or oncological reasons [8]
From November 2010 to August 2018, out of the 300 patients with various peritoneal malignancies who were treated at the Department of Surgical Oncology of the Medical University of Lublin, 48 patients with advanced GC and PM after neoadjuvant systemic chemotherapy had been scheduled for surgery with an attempt of complete cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), after signing informed consent form
Summary
The problem of synchronous peritoneal metastases (PM) in gastric cancer (GC) affects about 5% to. 30% of patients, whereas the incidence of peritoneal relapse is 46% to 54% [1,2]. Many metastasis-related factors, such as adhesion molecules, matrix proteases, and motility factors, are involved in a multistep process of the peritoneal dissemination [3]. The 5-year survival rate in the entire population of patients with GC is 15% to 20%; it decreases drastically with the stage of the disease. The 5-year survival rate reaches up to 55%, but in stage IV (M1), it does not exceed. When the presence of free cancer cells in the peritoneal fluid is found, the 5-year survival rate does not exceed 2% [6]. Risk factors for PM from primary GC include advanced tumour stage (T3/4), age < 60, female gender, poorly cohesive histological type (especially signet ring cell carcinoma), lymph node or liver metastases, angioinvasion, and the presence of malignant ascites [7]
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