Treatment options in synchronous peritoneal metastasis from gastric cancer: A retrospective cohort analysis

Abstract

Gastric cancer (GC) is a common malignancy and one of the leading causes of cancer related death. Peritoneal metastases (PM) are not uncommon and then prognosis is poor. Treatment options in these cases are not standardized. The use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) represents an option in selected patients. We retrospectively analyzed our prospectivey collected peritoneal surface malignancy database and assessed patients with synchronous peritoneal metastases from gastric primary based on peritoneal cancer index (PCI). Over a 16 year period, 600 such patients were identified. They were divided into 5 treatment groups based on their PCI. Surgical morbidity ranged from 5 to 22% and mortality from 1.4 to 3.8%. Overall survival was 7.3 months (range 3.9-14.8). PCI was an independent factor for increased overall survival and the most important factor for treatment decision making. Generally, patients with GC associated PM have poor prognosis. CRS and HIPEC can offer a survival benefit in carefully selected patients. Long-term survival was observed in patients with PCI≤7. Non-surgical approach can be equally effective for more advanced disease and palliative chemotherapy can offer a better quality of life.