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Gastric cancer with peritoneal metastases: a single center outline and comparison of different surgical and intraperitoneal treatments

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Abstract

Introduction

Gastric cancer with peritoneal metastasis (GCPM) has an unfavourable prognosis. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) are promising treatment options that have been shown to improve survival. The aim of this study was to assess the impact of different treatments such as systemic chemotherapy, systemic chemotherapy + PIPAC, and CRS + HIPEC in patients with GCPM.

Material and methods

This single-centre retrospective study included 82 patients with GCPM treated between January 2016 and June 2021. After first-line chemotherapy, depending on disease response and burden, the patients were divided into three treatment groups: chemotherapy alone, chemotherapy + PIPAC, and CRS + HIPEC. The primary outcome was overall survival (OS) from diagnosis, which was compared among the treatment groups.

Results

Thirty-seven (45.1%) patients were administered systemic chemotherapy alone, 25 (30.4%) received chemotherapy + PIPAC, and 20 (24.4%) underwent CRS + HIPEC. The CRS + HIPEC group had better OS (median 24 months) than the PIPAC group (15 months, p = 0.01) and chemotherapy group (5 months, p = 0.0001). Following CRS + HIPEC, the postoperative grade 3–4 complication rate was 25%, and no postoperative in-hospital deaths occurred. The median disease-free survival (DFS) was 12 months. Multivariate analysis identified peritoneal carcinomatosis index (PCI) > 7 as an independent predictor of worse DFS. No independent predictors of OS were identified.

Conclusion

Among patients with GCPM, we identified a highly selected population with oligometastatic disease. In this group, CRS + HIPEC provided a significant survival advantage with an acceptable major complication rate compared with other available therapies (systemic chemotherapy alone or in combination with PIPAC).

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Data availability

The data that support the findings of this study are not openly available due to reason of sensitivity.

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Authors and Affiliations

  1. Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Francesco Santullo, Federica Ferracci, Carlo Abatini, Miriam Attalla El Halabieh, Claudio Lodoli, Andrea Di Giorgio & Fabio Pacelli

  2. Catholic University of the Sacred Heart, Rome, Italy

    Giorgio D’Annibale, Ludovica Di Cesare & Luca D’Agostino

  3. Digestive Endoscopy Unit, Fondazione Policlinico A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Silvia Pecere

  4. Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Largo A. Gemelli 8, Rome, Italy

    Antonia Strippoli

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  1. Francesco Santullo
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  2. Federica Ferracci
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Contributions

Study conception and design: Francesco Santullo, Federica Ferracci. Acquisition of data: Federica Ferracci, Carlo Abatini, Miriam Attalla El Halabieh, Andrea Di Giorgio, Claudio Lodoli, Giorgio D’Annibale, Ludovica Di Cesare, Luca D’agostino, Silvia Pecere, Antonia Strippoli. Analysis and interpretation of data: Francesco Santullo, Federica Ferracci. Drafting of manuscript: Francesco Santullo, Federica Ferracci. Critical revision of manuscript: Francesco Santullo, Federica Ferracci, Antonia Strippoli, Fabio Pacelli.

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Correspondence to Federica Ferracci.

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Santullo, F., Ferracci, F., Abatini, C. et al. Gastric cancer with peritoneal metastases: a single center outline and comparison of different surgical and intraperitoneal treatments. Langenbecks Arch Surg 408, 437 (2023). https://doi.org/10.1007/s00423-023-03163-1

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