Prolonged hyperthermic intraperitoneal chemotherapy duration with 90 minutes cisplatin might increase overall survival in gastric cancer patients with peritoneal metastases

• Published in: World journal of gastroenterology : WJG 2023-05, Vol.29 (18), p.2850-2863
• Main Authors: Steinhoff, Heinrich, Acs, Miklos, Blaj, Sebastian, Dank, Magdolna, Herold, Magdolna, Herold, Zoltan, Herzberg, Jonas, Sanchez-Velazquez, Patricia, Strate, Tim, Szasz, Attila Marcell, Piso, Pompiliu
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - adverse effects; Cisplatin - therapeutic use; Combined Modality Therapy; Cytoreduction Surgical Procedures - adverse effects; Cytoreduction Surgical Procedures - methods; Humans; Hyperthermia, Induced - adverse effects; Hyperthermia, Induced - methods; Hyperthermic Intraperitoneal Chemotherapy - adverse effects; Peritoneal Neoplasms - secondary; Retrospective Studies; Retrospective Study; Stomach Neoplasms - pathology; Survival Rate; Trastuzumab - adverse effects
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v29.i18.2850

Advanced gastric cancer with synchronous peritoneal metastases (GC-PM) is associated with a poor prognosis. Although cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a promising approach, only a limited number of Western studies exist. To investigate the clinicopathological outcomes of patients who underwent CRS-HIPEC for GC-PM. A retrospective analysis of patients with GC-PM was conducted. All patients were seen at the Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany between January 2011 and July 2021 and underwent CRS-HIPEC. Preoperative laboratory results, the use of neoadjuvant trastuzumab, and the details of CRS-HIPEC, including peritoneal carcinomatosis index, completeness of cytoreduction, and surgical procedures were recorded. Disease-specific (DSS), and overall survival (OS) of patients were calculated. A total of 73 patients were included in the study. Patients treated with neoadjuvant trastuzumab ( = 5) showed longer DSS ( = 0.0482). Higher white blood cell counts (DSS: = 0.0433) and carcinoembryonic antigen levels (OS and DSS: < 0.01), and lower hemoglobin (OS and DSS: < 0.05) and serum total protein (OS: = 0.0368) levels were associated with shorter survival. Longer HIPEC duration was associated with more advantageous median survival times [60-min ( = 59): 12.86 mo; 90-min ( = 14): 27.30 mo], but without statistical difference. To obtain additional data from this observation, further separation of the study population was performed. First, propensity score-matched patient pairs ( = 14 in each group) were created. Statistically different DSS was found between patient pairs (hazard ratio = 0.2843; 95% confidence interval: 0.1119-0.7222; = 0.0082). Second, those patients who were treated with trastuzumab and/or had human epidermal growth factor receptor 2 positivity (median survival: 12.68 mo 24.02 mo), or had to undergo the procedure before 2016 (median survival: 12.68 mo 27.30 mo; = 0.0493) were removed from the original study population. Based on our experience, CRS-HIPEC is a safe and secure method to improve the survival of advanced GC-PM patients. Prolonged HIPEC duration may serve as a good therapy for these patients.