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Initial Experience Using Laparoscopic HIPEC for Gastric Cancer with Peritoneal Metastasis: Safety and Outcomes

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

Abstract

Background

Peritoneal metastases (PM) develop in approximately 20% of patients with gastric cancer (GC). For selected patients, treatment of PM with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has shown promising results. This report aims to describe the safety and perioperative outcomes of laparoscopic HIPEC for GC/PM.

Methods

This retrospective cohort study evaluated patients who had GC and PM treated with laparoscopic HIPEC (2018–2022). The HIPEC involved cisplatin and mitomycin C (MMC) or MMC alone. The primary end point was perioperative safety.

Results

The 22 patients in this study underwent 27 procedures. The mean age was 58 ± 13 years. All the patients were Eastern Cooperative Oncology Group (ECOG) 0 or 1 (55 and 45%, respectively). Five patients underwent a second laparoscopic HIPEC, with a median of 126 days (interquartile range [IQR], 117–166 days) between procedures. The median peritoneal carcinomatosis index (PCI) was 4 (IQR, 2–9), and the median hospital stay was 2 days (IQR, 1–3 days). No 30-day readmissions or complications occurred. Eight patients (36%) underwent gastrectomy (CRS ± HIPEC). After an average follow-up period of 11 months, 7 (32%) of the 22 patients were alive. The median overall survival was 11 months (IQR, 195–739 days) from the initial procedure and 19.3 months (IQR, 431–1204 days) from the diagnosis.

Conclusions

Laparoscopic HIPEC appears to be safe with minimal perioperative complications. Approximately one third of the patients undergoing initial laparoscopic HIPEC ultimately proceeded to cytoreduction and gastrectomy. Preliminary survival data from this highly selected cohort suggest that the addition of laparoscopic HIPEC to systemic chemotherapy does not compromise other treatment options. These initial results suggest that laparoscopic HIPEC may offer benefit to patients with GC and PM and aid in the selection of patients who may benefit from curative-intent resection.

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Author notes

  1. Meagan D. Read and Justin Drake are considered co-first authors.

Authors and Affiliations

  1. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Meagan D. Read MD, Justin Drake MD, Ghazal Hashemipour BS, Benjamin D. Powers MS, MD, Rutika Mehta MPH, MD, Andrew Sinnamon MD, MSCE, Jose M. Pimiento MD & Sean P. Dineen MD, MHPE

  2. Department of Surgery, Morsani College of Medicine, Tampa, FL, USA

    Meagan D. Read MD

  3. Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA

    Benjamin D. Powers MS, MD, Andrew Sinnamon MD, MSCE, Jose M. Pimiento MD & Sean P. Dineen MD, MHPE

  4. Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA

    Benjamin D. Powers MS, MD

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Correspondence to Sean P. Dineen MD, MHPE.

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DISCLOSURE

Dr. Rutika Mehta serves on the advisory board of BMS, Eli Lilly, Astellas, Novartis, Seagen, Boston Gene, Guardant Health, Merck, and Natera. Dr. Sean Dineen received consulting fees from Oncoinvent, a company interested in radiopharmaceuticals for peritoneal disease. This is not related to the current study. There are no conflicts of interest.

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Presented as an oral poster at the SSO International Conference on Advanced Cancer Therapies, February 2023.

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Read, M.D., Drake, J., Hashemipour, G. et al. Initial Experience Using Laparoscopic HIPEC for Gastric Cancer with Peritoneal Metastasis: Safety and Outcomes. Ann Surg Oncol 31, 3750–3757 (2024). https://doi.org/10.1245/s10434-024-15102-5

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