Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for advanced gastric cancer

Survival benefit of gastrectomy ± metastasectomy in patients with metastatic gastric cancer receiving chemotherapy

“…A recent meta-analysis of randomized trials that compared chemotherapy and best supportive care in patients with MGC revealed that chemotherapy was more beneficial than best supportive care alone with respect to OS and quality of life [20]. However, the role of surgery (debulking gastrectomy or gastrectomy plus metastasectomy) in GC patients with distant metastasis is still controversial [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The results of our study suggest that surgery may be beneficial in MGC patients when combined with chemotherapy.…”

“…GC mortality has remained high due to the frequent initial presentation with distant metastasis. Although surgery is mandatory for the cure of locoregional GC, the role of surgery for metastatic gastric cancer (MGC) is controversial [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. For patients with MGC, palliative chemotherapy and best supportive care are considered the only standard treatment to achieve extension of survival and palliation of symptoms [19].…”

“…Based on these results, some experts insist that debulking gastrectomy is the preferred choice for patients with MGC before the initiation of chemotherapy. In addition, there have been some studies of gastrectomy plus metastasectomy for patients with MGC [4][5][6][7][8][9][10]. However, the role of metastasectomy is also controversial, as is that of debulking gastrectomy, because previous studies with small sample sizes have shown various outcomes, with a median OS of 11.2-31.0 months [4][5][6][7][8][9][10].…”

“…In addition, there have been some studies of gastrectomy plus metastasectomy for patients with MGC [4][5][6][7][8][9][10]. However, the role of metastasectomy is also controversial, as is that of debulking gastrectomy, because previous studies with small sample sizes have shown various outcomes, with a median OS of 11.2-31.0 months [4][5][6][7][8][9][10]. Moreover, most previous studies evaluating the benefit of gastrectomy ± metastasectomy in MGC were performed without considering the effect of systemic chemotherapy-the only proven standard treatment in MGC [19]-and thus both patients who had and had not received systemic chemotherapy were included [3][4][5][6][8][9][10][11][12][13][14][15][16][17][18]; this has made many clinicians confused about the real benefits of surgery in MGC.…”

Update on Chemotherapeutic Agents Utilized for Perioperative Intraperitoneal Chemotherapy

“…It is important to note that no cases of thrombotic thrombocytopenic purpura, also known as hemolytic uremic syndrome, have been reported with the intraperitoneal use of this drug. Hall and colleagues have recently suggested an improved management of advanced gastric cancer when intraperitoneal hyperthermic chemotherapy was added to a complete resection; the further application of hyperthermic mitomycin C to surgical treatment of gastrointestinal cancer was discussed [24]. However, there is a marked difference in drug dosimetry.…”