Abstract
Background
The aim of this study was to review prognosis following gastrectomy for gastric cancer patients with synchronous peritoneal carcinomatosis and to identify predictive factors for improving survival after gastrectomy in this setting.
Methods
Records of all patients who underwent gastrectomy for gastric cancer with peritoneal dissemination in our center between 1993 and 2004 were reviewed.
Results
Data of 101 patients who underwent gastrectomy for gastric cancer with peritoneal dissemination were available. Peritoneal dissemination was classified as P1, metastasis to the adjacent peritoneum in 34 patients; P2, a few scattered metastases to the adjacent peritoneum in 13 patients; and P3, numerous metastases in 54 patients. Nineteen patients sustained 21 adverse events. Overall survival was significantly improved for those in the P1 and P2 groups compared with that for the P3 group (median of 18 months and 15 months vs. 9 months; P < 0.001). Seven factors were significant for overall survival: peritoneal carcinomatosis, peritoneal lavage cytology, macroscopic type, resection margin, extent of lymph node dissection, curative potential of gastric resection, and chemotherapy, including perioperative and postrecurrent chemotherapy. In multivariate analysis, two factors were identified as independently associated with poor survival: P3 disease (P = 0.002) and absence of chemotherapy (P = 0.009). Univariate analysis of gastric cancer patients with P1 or P2 carcinomatosis revealed only tumor differentiation to be significant.
Conclusions
Gastric cancer patients with P1/P2 carcinomatosis and well/moderately differentiated tumors are likely to have an improved survival after gastrectomy. We emphasize that patients with good performance status and P1/P2 carcinomatosis should be considered appropriate surgical candidates before embarking on palliative systemic chemotherapy alone.
Similar content being viewed by others
References
Okajima K, Yamada S (1986) Surgical treatment of far-advanced gastric cancer. Gan No Rinsho 32:1203–1209
Bando E, Yonemura Y, Takeshita Y et al (1999) Intraoperative lavage for cytological examination in 1, 297 patients with gastric carcinoma. Am J Surg 178:256–262
Boku T, Nakane Y, Minoura T et al (1990) Prognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer. Br J Surg 77:436–439
Sugarbaker PH, Yonemura Y (2000) Clinical pathway for the management of resectable gastric cancer with peritoneal seeding: best palliation with a ray of hope for cure. Oncology 58:96–107
Gretschel S, Siegel R, Estevez-Schwarz L et al (2006) Surgical strategies for gastric cancer with synchronous peritoneal carcinomatosis. Br J Surg 93:1530–1535
Bonenkamp JJ, Sasako M, Hermans J et al (2001) Tumor load and surgical palliation in gastric cancer. Hepatogastroenterology 48:1219–1221
Yoshikawa T, Kanari M, Tsuburaya A et al (2003) Should gastric cancer with peritoneal metastasis be treated surgically? Hepatogastroenterology 50:1712–1715
Chu DZ, Lang NP, Thompson C et al (1989) Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. Cancer 63:364–367
Sadeghi B, Arvieux C, Glehen O et al (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88:358–363
Ohtsu A, Shimada Y, Shirao K et al (2003) Randomized phase III trial of fluorouracil alone versus fluorouracil plus cisplatin versus uracil and tegafur plus mitomycin in patients with unrespectable, advanced gastric cancer: The Japan clinical oncology group study (JCOG9205). J Clin Oncol 21:54–59
Boku N (2008) Chemotherapy for metastatic disease: review from JCOG trials. Int J Clin Oncol 13:196–200
Koizumi W, Narahara H, Hara T et al (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9:215–221
Ouchi K, Sugawara T, Ono H et al (1998) Therapeutic significance of palliative operations for gastric cancer for survival and quality of life. J Surg Oncol 69:41–44
Hartgrink HH, Putter H, Klein Kranenbarg E et al (2002) Value of palliative resection in gastric cancer. Br J Surg 89:1438–1443
Haugstvedt T, Viste A, Eide GE et al (1989) The survival benefit of resection in patients with advanced stomach cancer: the Norwegian multicenter experience. Norwegian stomach cancer trial. World J Surg 13:617–621
Maeta M, Sugesawa A, Ikeguchi M et al (1994) Does the extent of lymph node dissection affect the postoperative survival of patients with gastric cancer and disseminating peritoneal metastasis? Surg Today 24:40–43
Kikuchi S, Arai Y, Morise M et al (1998) Gastric cancer with metastases to the distant peritoneum: a 20-year surgical experience. Hepatogastroenterology 45:1183–1188
Japanese Gastric Cancer Association (2001) Japanese classification of gastric carcinoma–2nd English edition–response assessment of chemotherapy and radiotherapy for gastric carcinoma: clinical criteria. Gastric Cancer 4:1–8
Japanese Research Society for Gastric Cancer (1995) Japanese classification of gastric carcinoma, 1st English ed. Kanehara & Co., Ltd., Tokyo
Harmon RL, Sugarbaker PH (2005) Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer. Int Semin Surg Oncol 2:3
Yonemura Y, Bandou E, Kawamura T et al (2006) Quantitative prognostic indicators of peritoneal dissemination of gastric cancer. Eur J Surg Oncol 32:602–606
Kahlke V, Bestmann B, Schmid A et al (2004) Palliation of metastatic gastric cancer: impact of preoperative symptoms and the type of operation on survival and quality of life. World J Surg 28:369–375
Kunisaki C, Shimada H, Akiyama H et al (2003) Survival benefit of palliative gastrectomy in advanced incurable gastric cancer. Anticancer Res 23:1853–1858
Sasako M, Sano T, Yamamoto S et al (2008) D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359(5):453–462
Kinoshita T, Sasako M, Sano T et al (2009) Phase II trial of S-1 for neoadjuvant chemotherapy against scirrhous gastric cancer (JCOG 0002). Gastric Cancer 12:37–42
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hioki, M., Gotohda, N., Konishi, M. et al. Predictive Factors Improving Survival After Gastrectomy in Gastric Cancer Patients with Peritoneal Carcinomatosis. World J Surg 34, 555–562 (2010). https://doi.org/10.1007/s00268-010-0396-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-010-0396-5