Abstract
Survival after potentially curative treatment of gastric cancer remains low, mostly due to peritoneal recurrence. This descriptive review gives an overview of available comparative studies concerning prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with gastric cancer with neither clinically evident metastases nor positive peritoneal cytology who undergo potentially curative gastrectomy. After searching the PubMed, Embase, CDSR, CENTRAL and ASCO meeting library, a total of 11 studies were included comparing surgery plus prophylactic HIPEC versus surgery alone (SA): three randomised controlled trials and eight non-randomised comparative studies, involving 1145 patients. Risk of bias was high in most of the studies. Morbidity after prophylactic HIPEC was 17–60% compared to 25–43% after SA. Overall survival was 32–35 months after prophylactic HIPEC and 22–28 months after SA. The 5-year survival rates were 39–87% after prophylactic HIPEC and 17–61% after SA, which was statistically significant in three studies. Peritoneal recurrence occurred in 7–27% in the HIPEC group, compared to 14–45% after SA. This review tends to demonstrate that prophylactic HIPEC for gastric cancer can be performed safely, may prevent peritoneal recurrence and may prolong survival. However, studies were heterogeneous and outdated, which emphasizes the need for well-designed trials conducted according to current standards.
Highlights
Gastric cancer is the fifth most common malignancy in the world and the third leading cause of cancer death [1]
In addition to the electronic search, four articles were retrieved after the citation screening, and one abstract was included from American Society of Clinical Oncology (ASCO)
The studies reported most of the selected endpoints, except for quality of life, which was not measured in any of the studies
Summary
Gastric cancer is the fifth most common malignancy in the world and the third leading cause of cancer death [1]. In patients with peritoneal recurrence, palliative chemotherapy is standard of care in order to try to eradicate cancer cells, but peritoneal penetration of chemotherapy is poor. To overcome this limitation, hyperthermic intraperitoneal chemotherapy (HIPEC) has been introduced [4,5]. The combination of HIPEC with cytoreductive surgery is the standard treatment for several peritoneal malignancies including colorectal cancer, pseudomyxomas and mesotheliomas [6,7,8], and has been used as a therapeutic option for peritoneal metastases from gastric cancer [9,10]
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