Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;31(13):8549-8559.
doi: 10.1245/s10434-024-16142-7. Epub 2024 Sep 5.

Survival Outcomes of Cytoreductive Surgery with HIPEC in Gastric Adenocarcinoma: A National Cancer Database Study

Andrii Khomiak  1 , Sumaya Ghaffar  1 , Salvador Rodriguez Franco  1 , Ioannis A Ziogas  1 , Elliott J Yee  1 , Oskar Franklin  2 , Ethan Cumbler  1 , Akshay Chauhan  1 , Martin D McCarter  1 , Ana L Gleisner  1 , Steven Ahrendt  1 , Marco Del Chiaro  1 , Richard D Schulick  1 , Benedetto Mungo  3
Affiliations

Survival Outcomes of Cytoreductive Surgery with HIPEC in Gastric Adenocarcinoma: A National Cancer Database Study

Andrii Khomiak et al. Ann Surg Oncol. 2024 Dec.

Abstract

Background: This study aimed to assess the impact of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) on the survival outcomes for patients with gastric cancer and peritoneal carcinomatosis (PC).

Methods: A retrospective analysis of the National Cancer Database from 2004 to 2020 identified patients with topography and histology codes consistent with gastric adenocarcinoma who underwent CRS/HIPEC. The exclusion criteria ruled out known other distant metastasis and missing key data. The study compared the CRS/HIPEC group with patients who had stage IV disease (with the same exclusions for distant metastases) and received systemic chemotherapy but no surgery to the primary site.

Results: The study included 148 patients who underwent CRS/HIPEC. Their median age was 57 years (interquartile range [IQR], 47-66 years), with 57.4% of the patients identifying as male and 73.6% identifying as white. Most of the CRS/HIPEC patients had locally advanced disease, with 33.8% having pT4 disease and 23% patients having pN3 status. The Charlson-Deyo scores were 0 for 77% and 1 for 16.9% of the patients. The overall survival (OS) among the stage IV patients managed with CRS/HIPEC was significantly longer than for the patients receiving only systemic chemotherapy (median survival, 18.1 vs 9.3 months; p < 0.001), and the 1-year OS was 72.6% versus 38.8% (p < 0.05)). Among the stage IV patients, CRS/HIPEC showed better survival than systemic chemotherapy (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.44-0.73; p < .001) when control was used for the Charlson Deyo score, histology, age, and sex.

Conclusions: These results suggest the association of CRS/HIPEC with improved survival for selected patients with gastric adenocarcinoma and peritoneal disease. Some of this difference may have been due to selection bias, but the differences in the survival curves are robust.

Keywords: Carcinomatosis; Cytoreductive surgery; Gastric cancer; HIPEC; Peritoneal metastasis.

PubMed Disclaimer

References

    1. Group UCSW. United States Cancer Statistics Data Visualizations Tool. Retrieved 5 January 2024 at https://gis.cdc.gov/Cancer/USCS/#/AtAGlance/ .
    1. Yang WJ, Zhao HP, Yu Y, et al. Updates on global epidemiology, risk, and prognostic factors of gastric cancer. World J Gastroenterol. 2023;29:2452–68. https://doi.org/10.3748/wjg.v29.i16.2452 . - DOI - PubMed - PMC
    1. Foster JM, Zhang C, Rehman S, Sharma P, Alexander HR. The contemporary management of peritoneal metastasis: a journey from the cold past of treatment futility to a warm present and a bright future. CA Cancer J Clin. 2023;73:49–71. https://doi.org/10.3322/caac.21749 . - DOI - PubMed
    1. Thomassen I, van Gestel YR, van Ramshorst B, et al. Peritoneal carcinomatosis of gastric origin: a population-based study on incidence, survival, and risk factors. Int J Cancer. 2014;134:622–8. https://doi.org/10.1002/ijc.28373 . - DOI - PubMed
    1. Badgwell B, Das P, Ajani J. Treatment of localized gastric and gastroesophageal adenocarcinoma: the role of accurate staging and preoperative therapy. J Hematol Oncol. 2017;10:149. https://doi.org/10.1186/s13045-017-0517-9 . - DOI - PubMed - PMC

MeSH terms

LinkOut - more resources