Prognostic impact of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer patients: A meta-analysis of randomized controlled trials |
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| Institution: | 1. General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy;2. University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy;3. University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy;4. General Surgery Unit, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy;5. General Surgery Unit, Department of Surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy;6. Peritoneal Surface Malignancies Unit, Fondazione I.R.C.C.S., Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy;7. Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Viale Luigi Pinto, 1, 71122, Foggia, Italy;1. Department of Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA;2. Division of Surgical Oncology, Department of Surgery, Henry Ford Hospital, 2800 West Grand Blvd, Detroit, MI, 48202, USA;3. Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI, 48202, USA;1. Dept. of Surgical Oncology, Zydus Hospital, Ahmedabad, India;2. Dept. of Surgical Oncology, Saifee Hospital, Mumbai, India;3. Dept. of Radiology, Centre Hospitalier Lyon-sud, Lyon, France;4. Dept. of Surgical Oncology, Jehangir Hospital, Pune, India;5. Dept. of Pathology, Zydus Hospital, Ahmedabad, India;6. Dept. of Radiology, Zydus Hospital, Ahmedabad, India;7. Dept. of Surgical Oncology, Centre Hospitalier Lyon-sud, Lyon, France;8. India Dept. of Pathology, Centre Hospitalier Lyon-sud, Lyon, France |
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| Abstract: | Backgroundgastric cancer patients frequently develop peritoneal metastases (PM) with a poor long-term prognosis. A solid body of evidence underlines the beneficial role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on survival, but to date, there is a lack of consensus regarding the optimal strategy in the treatment of locally advanced primary tumors with or without peritoneal metastasis. The present meta-analysis aims to assess the impact of CRS + HIPEC on survival analyzing the results of randomized studies only.MethodsA systematic review of articles was conducted according to PRISMA guidelines. Twelve studies were included in qualitative and quantitative analysis.ResultsA survival benefit for patients treated with CRS + HIPEC at all time points was highlighted. However, difference in survival was significant at all time points for patients treated for prophylaxis of PM, but no difference was found when considering resection with a curative intent. The 1, 2, 3 and 5-year survival rates (SR) for patients undergoing CRS + HIPEC were 86.9%, 70.5%, 63.7% and 55.7% respectively. CRS + HIPEC for the treatment rather than prophylaxis of PM was the only predictor of a reduced 3y SR.ConclusionsCRS + HIPEC may lead to improved prognosis for patients suffering from locally advanced gastric cancer in both prophylactic and curative settings. However, due to far from negligible postoperative morbidity and mortality rates, a strict patient selection is crucial to achieve the best results. The presence of extraperitoneal disease strongly limits the indication of this kind of surgery. |
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| Keywords: | Gastric cancer Peritoneal metastases Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Systematic review Meta-analysis |
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