HP40P A SYSTEMATIC REVIEW AND META‐ANALYSIS OF THE RANDOMISED CONTROLLED TRIALS ON ADJUVANT INTRAPERITONEAL CHEMOTHERAPY FOR ADVANCED GASTRIC CANCER

Abstract

Purpose The purpose of this systematic review and meta‐analysis was to determine the effectiveness and safety of adjuvant intraperitoneal chemotherapy for patients with advanced gastric cancer.Methodology Studies eligible for this systematic review included those in which patients with gastric cancer were randomly assigned to receive surgery combined with intraperitoneal chemotherapy versus surgery without intraperitoneal chemotherapy. The end‐points of the meta‐analysis were overall survival, incidence of recurrence, morbidity and mortality.Results Thirteen reports of RCTs were included for appraisal and data extraction. Ten reports were judged fair‐quality and subjected to the meta‐analysis. A significant improvement in survival was associated with hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) alone (HR = 0.60; 95% CI = 0.43 to 0.83; p = 0.002) or combined with early postoperative intraperitoneal chemotherapy (EPIC) (HR = 0.45; 95% CI = 0.29 to 0.68; p = 0.0002). Survival improvement was marginally significant (p = 0.06) with normothermic intraoperative intraperitoneal chemotherapy, but not significant with EPIC alone or delayed postoperative intraperitoneal chemotherapy. Intraperitoneal chemotherapy was also found to be associated with higher risks for intra‐abdominal abscess (RR = 2.37; 95% CI = 1.32 to 4.26; p = 0.003) and neutropenia (RR = 4.33; 95% CI = 1.49 to 12.61; p = 0.007).Conclusions The present meta‐analysis indicates that HIIC with or without EPIC after resection of advanced gastric primary cancer is associated with an improved overall survival. However, increased risks of intra‐abdominal abscess and neutropenia are demonstrated.