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Review
. 2024 May 18;16(10):1929.
doi: 10.3390/cancers16101929.

Efficacy of Cytoreductive Surgery (CRS) + HIPEC in Gastric Cancer with Peritoneal Metastasis: Systematic Review and Meta-Analysis

Lodovica Langellotti  1 , Claudio Fiorillo  2 , Giorgio D'Annibale  1 , Edoardo Panza  1 , Fabio Pacelli  1   3 , Sergio Alfieri  1   2 , Andrea Di Giorgio  3 , Francesco Santullo  3
Affiliations
Review

Efficacy of Cytoreductive Surgery (CRS) + HIPEC in Gastric Cancer with Peritoneal Metastasis: Systematic Review and Meta-Analysis

Lodovica Langellotti et al. Cancers (Basel). .

Abstract

Background: Peritoneal carcinomatosis is one of deadliest metastatic patterns of gastric cancer, being associated with a median overall survival (OS) of 4 months. Up to now, palliative systemic chemotherapy (pSC) has been the only recommended treatment. The aim of this study is to evaluate a potential survival benefit after CRS + HIPEC compared to pSC.

Methods: A systematic review was conducted according to the PRISMA guidelines in March 2024. Manuscripts reporting patients with peritoneal carcinomatosis from gastric cancer treated with CRS + HIPEC were included. A meta-analysis was performed, comparing the survival results between the CRS + HIPEC and pSC groups, and the primary outcome was the comparison in terms of OS. We performed random-effects meta-analysis of odds ratios (ORs). We assessed heterogeneity using the Q2 statistic.

Results: Out of the 24 papers included, 1369 patients underwent CRS + HIPEC, with a median OS range of 9.8-28.2 months; and 103 patients underwent pSC, with a median OS range of 4.9-8 months. CRS + HIPEC was associated with significantly increased survival compared to palliative systemic chemotherapy (-1.8954 (95% CI: -2.5761 to -1.2146; p < 0.001).

Conclusions: CRS + HIPEC could provide survival advantages in gastric cancer peritoneal metastasis compared to pSC.

Keywords: HIPEC; cytoreductive surgery; gastric cancer; peritoneal metastasis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure A1
Figure A1
Risk-of-bias assessment of retrospective cohort studies using the Newcastle–Ottawa scale (NOS) [8,9,10,11,12,13,15,16,17,18,19,20,21,22,24,25,26,27,30,31].
Figure A2
Figure A2
Risk-of-bias assessment of non-randomized clinical trials using Robin-I [8,29].
Figure A3
Figure A3
Risk-of-bias assessment of randomized clinical trials using Robin 2.0 [14,23,28].
Figure 1
Figure 1
PRISMA 2020 flow diagram for the systematic review. Records identified from PubMed (n = 1166) and Scopus (n = 3090). Records excluded for different population (reason 1), different outcome (reason 2), different study design (reason 3).
Figure 2
Figure 2
Graphical distribution of median OS of studies included, comparing CRS + HIPEC (blue) and pSC (orange).
Figure 3
Figure 3
Forrest plot showing survival rates comparing CRS + HIPEC and pCS [9,12,19,26].
See this image and copyright information in PMC

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