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Factors Associated with Resection and Survival After Laparoscopic HIPEC for Peritoneal Gastric Cancer Metastasis

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

Abstract

Purpose

Although laparoscopic hyperthermic intraperitoneal chemotherapy (LS-HIPEC) has been proven safe in patients with gastric adenocarcinoma and carcinomatosis or positive cytology, patient selection criteria remain unclear. Thus, we perform a retrospective analysis to identify factors associated with improved survival and resection rates.

Patients and Methods

Data for all patients undergoing LS-HIPEC for stage IV gastric adenocarcinoma between June 2014 and November 2018 were collected prospectively and analyzed for associations with survival and resection using uni- and multivariate logistic regression, Cox proportional hazards models, and Kaplan–Meier survival functions.

Results

Of 70 patients who underwent LS-HIPEC, 43 (61%) received two drugs (mitomycin C and cisplatin), and 27 (39%) received three drugs (mitomycin C, cisplatin, and paclitaxel). The two groups’ demographic and oncologic differences were not significant, although the three-drug group had a significantly lower rate of radiation therapy use (58% vs. 15%; p < 0.01). Univariate analysis revealed that poor differentiation [Cox hazard ratio (HR) 2.75; 95% confidence interval (CI) 1.34–5.63; p < 0.01], gross carcinomatosis (HR 3.10; 95% CI 1.52–6.30; p = 0.03), and ascites (HR 3.43; 95% CI 1.88–6.26; p < 0.01) were associated with shorter median survival. Gastrectomy was associated with improved overall survival (HR 0.32; 95% CI 0.15–0.70; p < 0.01). The resection rate of the 45 patients without ascites (38%) was significantly higher than that of the 25 patients with ascites (0%; p < 0.01).

Conclusions

Our findings identify ascites as a significant prognostic factor for gastric cancer patients with peritoneal metastases undergoing LS-HIPEC. Our findings can be used to help identify patients who are unlikely to proceed to resection after LS-HIPEC and are good candidates for novel therapeutic approaches or clinical trials.

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Acknowledgement

The authors thank Joseph Munch of the Department of Scientific Publications for editorial assistance. This trial was 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. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Michael G. White MD, MSc, Anai Kothari MD, MSc, Naruhiko Ikoma MD, Paul Mansfield MD & Brian Badgwell MD, MS

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

    Mariela Blum Murphy MD, Shumei Song MD & Jaffer Ajani MD

Authors
  1. Michael G. White MD, MSc
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  2. Anai Kothari MD, MSc
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  3. Naruhiko Ikoma MD
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  4. Mariela Blum Murphy MD
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  6. Jaffer Ajani MD
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  7. Paul Mansfield MD
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  8. Brian Badgwell MD, MS
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Correspondence to Brian Badgwell MD, MS.

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White, M.G., Kothari, A., Ikoma, N. et al. Factors Associated with Resection and Survival After Laparoscopic HIPEC for Peritoneal Gastric Cancer Metastasis. Ann Surg Oncol 27, 4963–4969 (2020). https://doi.org/10.1245/s10434-020-08842-7

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  • DOI: https://doi.org/10.1245/s10434-020-08842-7

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