Advanced gastric cancer with or without peritoneal carcinomatosis treated with hyperthermic intraperitoneal chemotherapy: A single western center experience

Scaringi, S.; Kianmanesh, R.; Sabate, J.M.; Facchiano, E.; Jouet, P.; Coffin, B.; Parmentier, G.; Hay, J.M.; Flamant, Y.; Msika, S.

doi:10.1016/j.ejso.2007.12.003

« Previous Next »European Journal of Surgical Oncology
Volume 34, Issue 11 , Pages 1246-1252, November 2008

Advanced gastric cancer with or without peritoneal carcinomatosis treated with hyperthermic intraperitoneal chemotherapy: A single western center experience

S. Scaringi
- Department of Surgery, Louis-Mourier University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris-VII University “Denis Diderot” (GHU Nord), 178 Rue des Renouillers, 92701 Colombes Cedex, France
R. Kianmanesh
- Department of Surgery, Louis-Mourier University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris-VII University “Denis Diderot” (GHU Nord), 178 Rue des Renouillers, 92701 Colombes Cedex, France
J.M. Sabate
- Department of Hepato-Gastro-Enterology, Louis-Mourier University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris-VII University “Denis Diderot” (GHU Nord), 178 Rue des Renouillers, 92701 Colombes Cedex, France
E. Facchiano
- Department of Surgery, Louis-Mourier University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris-VII University “Denis Diderot” (GHU Nord), 178 Rue des Renouillers, 92701 Colombes Cedex, France
P. Jouet
- Department of Hepato-Gastro-Enterology, Louis-Mourier University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris-VII University “Denis Diderot” (GHU Nord), 178 Rue des Renouillers, 92701 Colombes Cedex, France
B. Coffin
- Department of Hepato-Gastro-Enterology, Louis-Mourier University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris-VII University “Denis Diderot” (GHU Nord), 178 Rue des Renouillers, 92701 Colombes Cedex, France
G. Parmentier
- Department of Anaesthesiology, Louis-Mourier University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris-VII University “Denis Diderot” (GHU Nord), 178 Rue des Renouillers, 92701 Colombes Cedex, France
J.M. Hay
- Department of Surgery, Louis-Mourier University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris-VII University “Denis Diderot” (GHU Nord), 178 Rue des Renouillers, 92701 Colombes Cedex, France
Y. Flamant
- Department of Surgery, Louis-Mourier University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris-VII University “Denis Diderot” (GHU Nord), 178 Rue des Renouillers, 92701 Colombes Cedex, France
S. Msika
- Department of Surgery, Louis-Mourier University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris-VII University “Denis Diderot” (GHU Nord), 178 Rue des Renouillers, 92701 Colombes Cedex, France
- Corresponding author. Tel.: +33 1 4760 6381; fax: +33 1 4760 6392.

Accepted 10 December 2007.

Abstract

Introduction

The aim of this article was to evaluate the role of hyperthermic intraperitoneal chemotherapy (HIPEC), associated or not to cytoreductive surgery (CS) in the treatment of different stages of advanced gastric cancer (AGC).

Patients and methods

Thirty seven patients with AGC who underwent 43 HIPEC from June 1992 to February 2007 were included. HIPEC used Mitomycin-C and Cisplatin for 60–90min at 41–43°C intra-abdominal temperature. The main endpoints were long-term survivals, morbidity and mortality rates.

Results

Eleven patients had no demonstrable sign of PC and constituted the Prophylactic-group, while 26 patients had macroscopic PC (PC-group). Five patients were Gilly 1 or 2 (nodules <0.5cm) and 21 Gilly 3 or 4 (nodules ≥0.5cm). In the PC-group a complete curative CS was achieved before HIPEC in 8 (PC-curative subgroup) and a palliative HIPEC in 18 patients (PC-palliative subgroup). The overall 30-days mortality was 5% (2 patients). Two patients in the Prophylactic group died within 6months after hospital discharge (overall mortality 11%). The estimated risk of death per procedure was 9%. Ten patients (27%) presented one or more complications. The median survival was 23.4months in the Prophylactic group, and 6.6months in the PC-group (p<0.05). The median survival in the PC-curative subgroup was 15 vs 3.9months in the PC-palliative subgroup (p=0.007). The median survival according to Gilly classification was significantly different (Gilly 1&2 vs Gilly 3&4, 15 vs 4months respectively, p=0.014). The global recurrence rates between the Prophylactic group and the PC-curative subgroup at 2years were 36% vs 50% respectively. The median delay to recurrence was 18.5 vs 9.7months respectively.

Conclusion

HIPEC might be useful to improve the survival in selected patients with ACG only when a complete cytoreduction can be achieved. Despite encouraging data, prospective studies, based on larger cohorts of patients are required to assess the role of this procedure as a prophylactic treatment in patients with AGC.

Keywords: Advanced gastric cancer, Peritoneal carcinomatosis, Hyperthermic intraperitoneal chemotherapy, HIPEC, Surgical resection, Surgical cytoreduction

Abbreviations: CS, cytoreductive surgery, ip, intraperitoneal, iv, intravenous, HIPEC, hyperthermic intraperitoneal chemotherapy, PC, peritoneal carcinomatosis, CCR, completeness of cancer resection, vs, versus