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. 2022 Mar 8:12:852559.
doi: 10.3389/fonc.2022.852559. eCollection 2022.

Conversion Surgery in Gastric Cancer Carcinomatosis

Paolo Morgagni  1 , Leonardo Solaini  1   2 , Luca Saragoni  3 , Manlio Monti  4 , Martina Valgiusti  4 , Giovanni Vittimberga  1 , Giovanni Luca Frassineti  4 , Massimo Framarini  1 , Giorgio Ercolani  1   2
Affiliations

Conversion Surgery in Gastric Cancer Carcinomatosis

Paolo Morgagni et al. Front Oncol. .

Abstract

Background: After the REGATTA trial, patients with stage IV gastric cancer could only benefit from chemotherapy (CHT). However, some of these patients may respond extraordinarily to palliative chemotherapy, converting their disease to a radically operable stage. We present a single centre experience in treating peritoneal carcinomatosis from gastric cancer.

Methods: All patients with stage IV gastric cancer with peritoneal metastases as a single metastatic site operated at a single centre between 2005 and 2020 were included. Cases were grouped according to the treatment received.

Results: A total of 118 patients were considered, 46 were submitted to palliative gastrectomy (11 were considered M1 because of an unsuspected positive peritoneal cytology), and 20 were submitted to Hyperthermic Intraperitoneal Chemotherapy (HIPEC) because of a <6 Peritoneal Cancer Index (PCI). The median overall survival (OS) after surgery plus HIPEC was 46.7 (95% CI 15.8-64.0). Surgery (without HIPEC) after CHT presented a median OS 14.4 (8.2-26.8) and after upfront surgery 14.7 (10.9-21.1). Patients treated with upfront surgery and considered M1 only because of a positive cytology, had a median OS of 29.2 (25.2-29.2). The OS of patients treated with surgery plus HIPEC were 60.4 months (9.2-60.4) in completely regressed cancer after chemotherapy and 31.2 (15.8-64.0) in those partially regressed (p = 0.742).

Conclusions: Conversion surgery for peritoneal carcinomatosis from gastric cancer was associated with long survival and it should always be taken into consideration in this group of patients.

Keywords: HIPEC; conversion surgery; gastric cancer; metastatic disease; positive peritoneal cytology.

PubMed Disclaimer

Conflict of interest statement

The Handling Editor declared a past co-authorship with the authors GE, LS and PM.

Figures

Figure 1
Figure 1
Flow-chart shows the types of treatment.
Figure 2
Figure 2
Group1: HIPEC, palliative chemotherapy followed by surgery plus HIPEC; Group 2: surgery after CTH without HIPEC; Group 3: upfront surgery; Group 4: upfront surgery in positive Cy+ only.
Figure 3
Figure 3
Survival rates for Group 1: CR-HIPEC, completely regressed followed by surgery plus HIPEC; Group 2: PR-HIPEC, partially regressed followed by surgery plus HIPEC.
See this image and copyright information in PMC

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