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Patients with Peritoneal Carcinomatosis from Gastric Cancer Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Is Cure a Possibility?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Peritoneal carcinomatosis is an increasingly common finding in gastric carcinoma. Previously, patients were treated as terminal, and median survival was poor. The use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in this context is still highly debatable.

Objective

The aim of this study was to evaluate the long-term outcomes associated with CRS and HIPEC, and define prognostic factors for cure, if possible.

Patients and Methods

All patients with gastric carcinomatosis from five French institutions who underwent combined complete CRS and HIPEC and had a minimum follow-up of 5 years were included in this study. Cure was defined as a disease-free interval of more than 5 years from the last treatment until the last follow-up.

Results

Of the 81 patients who underwent CRS and HIPEC from 1989 to 2009, 59 had a completeness of cytoreduction score (CCS) of 0 (complete macroscopic resection), and the median Peritoneal Cancer Index (PCI) score was 6. Mitomycin C was the most commonly used drug during HIPEC (88 %). The 5-year overall survival (OS) rate was 18 %, with nine patients still disease-free at 5 years, for a cure rate of 11 %. All ‘cured’ patients had a PCI score below 7 and a CCS of 0. Factors associated with improved OS on multivariate analysis were synchronous resection (p = 0.02), a lower PCI score (p = 0.12), and the CCS (p = 0.09).

Conclusion

The cure rate of 11 % for patients with gastric carcinomatosis who are deemed terminal emphasizes that CRS and HIPEC should be considered in highly selected patients (low disease extent and complete CRS).

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Acknowledgment

The authors thank Isabelle Bonnefoy for data collection, and Emilie Durand and Christelle Maurice for statistical analysis validation.

Disclosures

Claramae S. Chia, Benoît You, Evelyne Decullier, Delphine Vaudoyer, Gérard Lorimier, Karine Abboud, Jean-Marc Bereder, Catherine Arvieux, Gilles Boschetti, and Olivier Glehen have no financial disclosures or conflict of interests.

Author information

Authors and Affiliations

  1. Hospices Civils de Lyon, Department of General and Oncologic Surgery, Cancer Institute, Pierre Bénite, France

    C. S. Chia MBBS, MMed, FRCS, D. Vaudoyer MD & O. Glehen MD, PhD

  2. Hospices Civils de Lyon, Department of Oncology, Cancer Institute of HCL, Pierre Bénite, France

    B. You MD, PhD

  3. Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France

    E. Decullier PhD

  4. Université de Lyon, RECIF, EA Santé Individu Société 4129, Lyon, France

    E. Decullier PhD

  5. Université Lyon 1, Lyon, France

    E. Decullier PhD

  6. Service de Chirurgie Digestive et Cancérologique, Centre P. Papin, Angers, France

    G. Lorimier MD

  7. Service de Chirurgie Générale, Hopital Nord, St Etienne, France

    K. Abboud MD

  8. Service de Chirurgie Générale et Cancérologie Digestive, CHU L’Archet II, Nice, France

    J.-M. Bereder MD

  9. Service de Chirurgie Digestive, CHU A. Michallon, Grenoble, France

    C. Arvieux MD, PhD

  10. Department of Hepatogastroenterology, Cancer Institute of HCL, Lyon Sud, Pierre Bénite, France

    G. Boschetti MD

  11. Université Lyon 1, Research Unit EMR 3738, Lyon, France

    B. You MD, PhD, K. Abboud MD, C. Arvieux MD, PhD & O. Glehen MD, PhD

  12. Surgical Oncology Department, CHRU Lyon Sud, Pierre Bénite, Cedex, France

    O. Glehen MD, PhD

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  1. C. S. Chia MBBS, MMed, FRCS
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  2. B. You MD, PhD
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the BIG RENAPE Group

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Correspondence to C. S. Chia MBBS, MMed, FRCS.

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Chia, C.S., You, B., Decullier, E. et al. Patients with Peritoneal Carcinomatosis from Gastric Cancer Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Is Cure a Possibility?. Ann Surg Oncol 23, 1971–1979 (2016). https://doi.org/10.1245/s10434-015-5081-3

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  • DOI: https://doi.org/10.1245/s10434-015-5081-3

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