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Peritoneal Carcinomatosis from Gastric Cancer: A Multi-Institutional Study of 159 Patients Treated by Cytoreductive Surgery Combined with Perioperative Intraperitoneal Chemotherapy

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

Abstract

Background

Peritoneal carcinomatosis (PC) from gastric cancer has long been regarded a terminal disease with a short median survival. New locoregional therapeutic approaches combining cytoreductive surgery with perioperative intraperitoneal chemotherapy (PIC) have evolved and suggest improved survival.

Materials and Methods

A retrospective multicentric study was performed in French-speaking centers to evaluate the toxicity and the principal prognostic factors in order to identify the best indications. All patients had cytoreductive surgery and PIC: hyperthermic intraperitoneal chemotherapy (HIPEC) and/or early postoperative intraperitoneal chemotherapy (EPIC).

Results

The study included 159 patients from 15 institutions between February 1989 and August 2007. The median follow-up was 20.4 months. HIPEC was the PIC used for 150 procedures. Postoperative mortality and grade 3–4 morbidity rates were 6.5 and 27.8%, respectively. By multivariate analysis, the institution had a significant influence on toxicity. The overall median survival was 9.2 months and 1-, 3-, and 5-year survival rates were 43, 18, and 13%, respectively. The only independent prognostic indicator by multivariate analysis was the completeness of cytoreductive surgery. For patients treated by complete cytoreductive surgery, the median survival was 15 months with a 1-, 3-, and 5-year survival rate of 61, 30, and 23%, respectively.

Conclusions

The therapeutic approach combining cytoreductive surgery with PIC for patients with gastric carcinomatosis may achieve long-term survival in a selected group of patients (limited and resectable PC). The high mortality rate underlines this necessarily strict selection that should be reserved to experienced institutions involved in the management of PC and gastric surgery.

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References

  1. Ikeguchi M, Oka A, Tsujitani S, Maeta M, Kaibara N. Relationship between area of serosal invasion and intraperitoneal free cancer cells in patients with gastric cancer. Anticancer Res. 1994;14:2131–4.

    PubMed  CAS  Google Scholar 

  2. Kuramoto M, Shimada S, Ikeshima S, Matsuo A, Yagi Y, Matsuda M, et al. Extensive intraoperative peritoneal lavage as a standard prophylactic strategy for peritoneal recurrence in patients with gastric carcinoma. Ann Surg. 2009;250:242–6.

    Article  PubMed  Google Scholar 

  3. Glehen O MF, Gilly FN. Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol. 2004;5:219–28.

    Article  PubMed  Google Scholar 

  4. Sugarbaker PH. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol. 2006;7:69–76.

    Article  PubMed  Google Scholar 

  5. Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H. 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2008;15:2426–32.

    Article  PubMed  Google Scholar 

  6. Yan TD, Morris DL. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for isolated colorectal peritoneal carcinomatosis: experimental therapy or standard of care? Ann Surg. 2008;248:829–35.

    PubMed  Google Scholar 

  7. Yan TD, Welch L, Black D, Sugarbaker PH. A systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignancy peritoneal mesothelioma. Ann Oncol. 2007;18:827–34.

    Article  PubMed  CAS  Google Scholar 

  8. Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221:29–42.

    Article  PubMed  CAS  Google Scholar 

  9. Elias D, Benizri E, Di Pietrantonio D, Menegon P, Malka D, Raynard B. Comparison of two kinds of intraperitoneal chemotherapy following complete cytoreductive surgery of colorectal peritoneal carcinomatosis. Ann Surg Oncol. 2007;14:509–14.

    Article  PubMed  Google Scholar 

  10. Sugarbaker PH. Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol. 1998;14:254–61.

    Article  PubMed  CAS  Google Scholar 

  11. Glehen O, Cotte E, Kusamura S, Deraco M, Baratti D, Passot G, et al. Hyperthermic intraperitoneal chemotherapy: nomenclature and modalities of perfusion. J Surg Oncol. 2008;98:242–6.

    Article  PubMed  Google Scholar 

  12. Deraco M, Nonaka D, Baratti D, Casali P, Rosai J, Younan R, et al. Prognostic analysis of clinicopathologic factors in 49 patients with diffuse malignant peritoneal mesothelioma treated with cytoreductive surgery and intraperitoneal hyperthermic perfusion. Ann Surg Oncol. 2006;13:229–37.

    Article  PubMed  Google Scholar 

  13. Glehen O SV, Cotte E, Sayag-Beaujard AC, Osinsky D, Freyer G, Francois Y, et al. Cytoreductive surgery and intraperitoneal chemohyperthermia for peritoneal carcinomatosis arising from gastric cancer. Arch Surg. 2004;139:20–6.

    Article  PubMed  CAS  Google Scholar 

  14. Elias D, Lefevre JH, Chevalier J, Brouquet A, Marchal F, Classe JM, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009;27:681–5.

    Article  PubMed  Google Scholar 

  15. Shen P, Thai K, Stewart JH, Howerton R, Loggie BW, Russell GB, et al. Peritoneal surface disease from colorectal cancer: comparison with the hepatic metastases surgical paradigm in optimally resected patients. Ann Surg Oncol. 2008;15:3422–32.

    Article  PubMed  Google Scholar 

  16. Gilly FN, Carry PY, Sayag AC, Brachet A, Panteix G, Salle B, et al. Regional chemotherapy (with mitomycin C) and intra-operative hyperthermia for digestive cancers with peritoneal carcinomatosis. Hepatogastroenterology. 1994;41:124–9.

    PubMed  CAS  Google Scholar 

  17. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74.

    PubMed  CAS  Google Scholar 

  18. Yonemura Y, Kawamura T, Bandou E, Takahashi S, Sawa T, Matsuki N. Treatment of peritoneal dissemination from gastric cancer by peritonectomy and chemohyperthermic peritoneal perfusion. Br J Surg. 2005;92:370–5.

    Article  PubMed  CAS  Google Scholar 

  19. Fujimoto S, Takahashi M, Mutou T, Kobayashi K, Toyosawa T, Isawa E, et al. Improved mortality rate of gastric carcinoma patients with peritoneal carcinomatosis treated with intraperitoneal hyperthermic chemoperfusion combined with surgery. Cancer. 1997;79:884–91.

    Article  PubMed  CAS  Google Scholar 

  20. Yonemura Y, Fujimura T, Nishimura G, FallaR, Sawa T, Katayama K, et al. Effects of intraoperative chemohyperthermia in patients with gastric cancer with peritoneal dissemination. Surgery. 1996;119:437–44.

    Article  PubMed  CAS  Google Scholar 

  21. Moran BJ. Decision-making and technical factors account for the learning curve in complex surgery. J Public Health (Oxf). 2006;28:375–8.

    Article  CAS  Google Scholar 

  22. Smeenk RM, Verwaal VJ, Zoetmulder FA. Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg. 2007;94:1408–14.

    Article  PubMed  CAS  Google Scholar 

  23. Yan TD, Links M, Fransi S, Jacques T, Black D, Saunders V, et al. Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancy—a journey to becoming a Nationally Funded Peritonectomy Center. Ann Surg Oncol. 2007;14:2270–80.

    Article  PubMed  Google Scholar 

  24. Mohamed F, Moran BJ. Morbidity and mortality with cytoreductive surgery and intraperitoneal chemotherapy: the importance of a learning curve. Cancer J. 2009;15:196–9.

    Article  PubMed  Google Scholar 

  25. Piso P, Slowik P, Popp F, Dahlke MH, Glockzin G, Schlitt HJ. Safety of gastric resections during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. Ann Surg Oncol. 2009;16:2188–94.

    Article  PubMed  Google Scholar 

  26. Hall JJ, Loggie BW, Shen P, Beamer S, Douglas Case L, et al. Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for advanced gastric cancer. J Gastrointest Surg. 2004;8:454–63.

    Article  PubMed  Google Scholar 

  27. Song KY, Kim JJ, Kim SN, Park CH. Staging laparoscopy for advanced gastric cancer: is it also useful for the group which has an aggressive surgical strategy? World J Surg. 2007;31:1230–5.

    Article  Google Scholar 

  28. Badgwell B, Cormier JN, Krishnan S, Yao J, Staerkel GA, Lupo PJ, et al. Does neoadjuvant treatment for gastric cancer patients with positive peritoneal cytology at staging laparoscopy improve survival? Ann Surg Oncol. 2008;15:2684–91.

    Article  PubMed  Google Scholar 

  29. Garofalo A, Valle M. Laparoscopy in the management of peritoneal carcinomatosis. Cancer J. 2009;15:190–5.

    Article  PubMed  Google Scholar 

  30. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.

    Article  PubMed  CAS  Google Scholar 

  31. Yonemura Y, de Aretxabala X, Fujimura T, Fushida S, Katayama K, Bandou E, et al. Intraoperative chemohyperthermic peritoneal perfusion as an adjuvant to gastric cancer: final results of a randomized controlled study. Hepatogastroenterology. 2001;48:1776–82.

    PubMed  CAS  Google Scholar 

  32. Fujimoto S, Takahashi M, Mutou T, Kobayashi K, Toyosawa T. Successful intraperitoneal hyperthermic chemoperfusion for the prevention of postoperative peritoneal recurrence in patients with advanced gastric carcinoma. Cancer. 1999;85:529–34.

    Article  PubMed  CAS  Google Scholar 

  33. Kim JY, Bae HS. A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP). Gastric Cancer. 2001;4:27–33.

    Article  PubMed  CAS  Google Scholar 

  34. Zhu ZG, Tang R, Yan M, Chen J, Yang QM, Li C, et al. Efficacy and safety of intraoperative peritoneal hyperthermic chemotherapy for advanced gastric cancer patients with serosal invasion. A long-term follow-up study. Dig Surg. 2006;23:93–102.

    Article  PubMed  Google Scholar 

  35. Scaringi S, Kianmanesh R, Sabate JM, Facchiano E, Jouet P, Coffin B, et al. Advanced gastric cancer with or without peritoneal carcinomatosis treated with hyperthermic intra-peritoneal-chemotherapy: a single western center experience. Eur J Surg Oncol. 2008;34:1246–52.

    PubMed  CAS  Google Scholar 

  36. De Roover A, Detroz B, Detry O, Coimbra C, Polus M, Belaiche J, et al. Adjuvant hyperthermic intraperitoneal perioperative chemotherapy (HIPEC) associated with curative surgery for locally advanced gastric carcinoma. An initial experience. Acta Chir Belg. 2006;106:297–301.

    PubMed  Google Scholar 

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Acknowledgment

Acknowledgements to Faheez Mohamed for help with English editing and to other authors of Association Française de Chirurgie: Jack Porcheron and Karine Abboud (CHU St Etienne), Lucas Sideris (Hopital Maisonneuve Rosemont, Montréal),Turrini Olivier (Centre Paoli Calmette, Marseille), Arvieux Catherine (CHU Grenoble), Rat Patrick (CHU Dijon), Gertsch Philippe (Hopital San Giovanni, Bellinzona), Ferron Gwenael (Centre Claudius Regaud, Toulouse), Meeus Pierre (Centre Léon Bérard, Lyon), Brigand Cécile (CHU Strasbourg), Marchal Frederic (Centre Alexis Vautrin, Nancy), Tuech Jean Jacques (Centre Charles Nicolle, Rouen), Pocard Marc (Hopital Lariboisière, APHP), Loungnarath Rasmy (Hopital St Luc, Montréal), Tasseti Vincent (Centre Emile Muller, Mulhouse), Lermite Emily (CHU Angers), Durand Sylvaine (Centre Dupuytren, Limoges), Van der Speeten Kurt (Zieken Oost Limburg, Genk).

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Correspondence to Olivier Glehen MD, PhD.

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Glehen, O., Gilly, F.N., Arvieux, C. et al. Peritoneal Carcinomatosis from Gastric Cancer: A Multi-Institutional Study of 159 Patients Treated by Cytoreductive Surgery Combined with Perioperative Intraperitoneal Chemotherapy. Ann Surg Oncol 17, 2370–2377 (2010). https://doi.org/10.1245/s10434-010-1039-7

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