OGC O07 Effect of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) on survival and recurrence rates in advanced gastric cancer- systematic review and meta analysis

Abstract

Abstract Background Around 5–20% of patients who undergo surgery for advanced gastric cancer have peritoneal carcinomatosis and 10–54% have peritoneal recurrence after surgery, which is associated with poor prognosis. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced gastric cancer (AGC) is not clearly defined. We performed a meta-analysis to assess the safety and survival benefit of HIPEC in AGC. Methods We conducted a meta-analysis, in accordance with the PRISMA guidelines, of the clinical trials and high-quality non-randomized studies evaluating the role of HIPEC in AGC over the last 10 years. The studies were searched in PubMed, EMBASE, MEDLINE and Cochrane databases between January 2011 to December 202. The PROSPERO registration number is CRD42022310556. Clinical data including overall survival (OS), recurrence-free survival, overall recurrence rate, peritoneal recurrence rate, and complications analyzed after data extraction using RevMan5.4.The primary endpoint was overall survival. The secondary end points were 5 year survival, disease-free survival, post operative complications: myelosuppression, liver dysfunction, intestinal obstruction, leak, and mortality. The impact of HIPEC on overall and peritoneal recurrence was also evaluated. Results Six randomized controlled trials and 10 nonrandomized studies met the inclusion criteria and were included in the meta-analysis, comprising a total of 1700 patients. While the use of HIPEC did not impact OS at one year, it was associated with significantly improved OS at 3 (OR 1.89, 95% CI 1.17–3.05) and at 5 years (OR 1.87, 95% CI 1.29–2.71). HIPEC was associated with reduced overall recurrence (OR 0.49, 95% CI 0.31–0.80) and peritoneal recurrence (OR 0.22, 95% 0.11–0.47). HIPEC was not associated with increased complications; however, the occurrence of postoperative renal dysfunction was significantly higher in the HIPEC group (OR 3.94, 95% CI 1.85–8.38). 3-year mortality was significantly favorable to HIPEC (OR 0.38, 95% CI 0.18–0.82). Conclusions The role of HIPEC in AGC has evolved over the past decade. These results suggest that HIPEC may improve survival rates and reduce recurrence rates in patients with AGC, without significant increase in complications. HIPEC may improve survival rates and reduce recurrence rates in patients with AGC, without any significant increase in complications with a favorable impact on 3 and 5-year survival. The prognosis is dependent on patient selection. High quality, multi-centre trials are needed to guide in patient selection and developing standardized protocols for the management for this cohort of patients.