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Laparoscopic HIPEC for Low-Volume Peritoneal Metastasis in Gastric and Gastroesophageal Adenocarcinoma

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We seek to determine whether laparoscopic hyperthermic intraperitoneal chemoperfusion (LS-HIPEC) improves overall survival (OS) in patients with gastric and gastroesophageal adenocarcinoma and low-volume peritoneal metastasis compared with standard of care treatment.

Patients and Methods

We reviewed data from a prospectively maintained database of patients with gastric and gastroesophageal adenocarcinoma to identify patients with radiologically occult carcinomatosis or positive peritoneal cytology, no evidence of distant metastasis, and without disease progression during initial chemotherapy or observation. Univariate and multivariable analyses were performed to evaluate the impact of LS-HIPEC on OS.

Results

We identified 25 patients who underwent LS-HIPEC and 27 treated with a standard of care approach due to patient (33.3%) or provider (51.9%) preference or financial limitations/lack of insurance coverage (14.8%). Resection was ultimately performed in 28% of LS-HIPEC patients and no standard care patients. At a median follow-up of 18.9 months, median OS was 24.7 (IQR 20.8–34.2) months in LS-HIPEC patients and 21.3 (IQR 12.3–23.1) months in standard care patients (p = 0.08). Three-year OS in the LS-HIPEC group was 19.1%, compared with 9.6% (p = 0.08). Patients who underwent resection had a median OS of 25.3 (IQR 22.6–47.1) months compared with 21.3 months in standard care patients (p = 0.05).

Conclusions

Neoadjuvant LS-HIPEC for the treatment of low-volume peritoneal disease in gastric and gastroesophageal cancer patients did not significantly improve OS compared with standard care. Multiinstitutional studies are necessary to further elucidate the benefit of LS-HIPEC for this patient population.

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Acknowledgment

This work was supported by National Institutes of Health T32 CA 009599 and the MD Anderson Cancer Center support grant (P30 CA016672). This study was also supported by the Holly Clegg Gastric Cancer Research Fund and the No Stomach for Cancer Award for Gastric Cancer Research. Editorial support was provided by Bryan Tutt in Scientific Publications Services, Research Medical Library.

Funding

This work was supported by National Institutes of Health T32 CA 009599 and the MD Anderson Cancer Center support grant (P30 CA016672). This study was also supported by the Holly Clegg Gastric Cancer Research Fund and the No Stomach for Cancer Award for Gastric Cancer Research.

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Authors and Affiliations

  1. Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Alisa N. Blumenthaler MD, Casey J. Allen MD, Naruhiko Ikoma MD, Paul F. Mansfield MD & Brian D. Badgwell MD, MS

  2. Departments of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariela Blum MD & Jaffer A. Ajani MD

  3. Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Prajnan Das MD & Bruce D. Minsky MD

Authors
  1. Alisa N. Blumenthaler MD
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  2. Casey J. Allen MD
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  3. Naruhiko Ikoma MD
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  9. Brian D. Badgwell MD, MS
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Correspondence to Brian D. Badgwell MD, MS.

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Prajnan Das—honorarium Adlai Nortye and MD Anderson Cancer Center, Madrid, Spain.

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Blumenthaler, A.N., Allen, C.J., Ikoma, N. et al. Laparoscopic HIPEC for Low-Volume Peritoneal Metastasis in Gastric and Gastroesophageal Adenocarcinoma. Ann Surg Oncol 27, 5047–5056 (2020). https://doi.org/10.1245/s10434-020-08968-8

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