Role of prophylactic hyperthermic intraperitoneal chemotherapy in patients with locally advanced gastric cancer

Tian-Yu Xie; Di Wu; Shuo Li; Zhao-Yan Qiu; Qi-Ying Song; Da Guan; Li-Peng Wang; Xiong-Guang Li; Feng Duan; Xin-Xin Wang

doi:10.4251/wjgo.v12.i7.782

Role of prophylactic hyperthermic intraperitoneal chemotherapy in patients with locally advanced gastric cancer

World J Gastrointest Oncol. 2020 Jul 15;12(7):782-790. doi: 10.4251/wjgo.v12.i7.782.

Authors

Tian-Yu Xie¹, Di Wu², Shuo Li¹, Zhao-Yan Qiu², Qi-Ying Song², Da Guan², Li-Peng Wang², Xiong-Guang Li¹, Feng Duan², Xin-Xin Wang³

Affiliations

¹ School of Medicine, Nankai University, Tianjin 300071, China.
² Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China.
³ Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China. 301wxx@sina.com.

Abstract

Background: Gastric cancer is the second most common malignant tumor in China, ranking third among all malignant tumor mortality rates. Hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to increase significantly the effectiveness of intraperitoneal chemotherapeutic drugs, prolong the action time of these drugs on intraperitoneal tumor cells, and enhance their diffusion in tumor tissues. HIPEC may be one of the best choices for the eradication of residual cancer cells in the abdominal cavity.

Aim: The aim of this study was to study the role of preventive HIPEC after radical gastrectomy.

Methods: A prospective analysis was performed with patients with cT₄N_0-3M₀ gastric cancer to compare the effects of postoperative prophylactic HIPEC plus intravenous chemotherapy with those of routine adjuvant chemotherapy. Patients' medical records were analyzed, and differences in the peritoneal recurrence rate, disease-free survival time, and total survival time between groups were examined.

Results: The first site of tumor recurrence was the peritoneum in 11 cases in the conventional adjuvant chemotherapy group and in 2 cases in the HIPEC group (P = 0.020). The 1-year and 3-year disease-free survival rates were 91.9% and 60.4%, respectively, in the conventional adjuvant chemotherapy group and 92.1% and 63.0%, respectively, in the HIPEC group. The 1-year and 3-year overall survival rates were 95.2% and 66.3%, respectively, in the conventional adjuvant chemotherapy group and 96.1% and 68.6%, respectively, in the HIPEC group. No significant difference in postoperative or chemotherapy complications was observed between groups.

Conclusion: In patients with cT₄N_0-3M₀ gastric cancer, prophylactic HIPEC after radical tumor surgery is beneficial to reduce peritoneal tumor recurrence and prolong survival.

Keywords: Disease-free survival; Gastric cancer; Hyperthermic intraperitoneal chemotherapy; Locally advanced; Overall survival; Prognosis.