Efficacy of Continuous Hyperthermic Peritoneal Perfusion for the Prophylaxis and Treatment of Peritoneal Metastasis of Advanced Gastric Cancer: Evaluation by Multivariate Regression Analysis

Abstract

Thirty-two patients with advanced gastric cancer underwent continuous hyperthermic peritoneal perfusion (CHPP) combined with surgery: to prevent peritoneal recurrence in 15 patients without peritoneal metastasis (prophylactic CHPP) and to treat 17 patients with peritoneal metastases (therapeutic CHPP). The postoperative outcome was compared with that of control patients treated with surgery alone. Peritoneal recurrence was less frequent (26%) and the 5-year survival rate was significantly higher (39%) in the patients with prophylactic CHPP than in 40 control patients (42 and 17%, respectively). The patients with therapeutic CHPP showed significantly better median survival than did 20 control patients (11 vs. 6 months). Cox multivariate regression analysis revealed that CHPP was an independent prognostic factor in the prophylactic study (hazard ratio = 0.3965), and that the independent prognostic factor in the therapeutic study was not CHPP but complete resection of the peritoneal metastasis. Thus, CHPP has no marked benefit for established peritoneal metastasis. CHPP for the prevention of peritoneal recurrence may have a beneficial effect on long-term survival, but a prospective randomized trial is needed to clarify its prognostic value.

The impact of hyperthermic chemotherapy on human gastric cancer cell lines: Preliminary results

“…Routine systemic chemotherapy is inefficient for both the prevention and treatment of peritoneal dissemination due to the existence of the peritoneal-plasma barrier. Intraperitoneal hyperthermic chemotherapy (IPHC) has also been introduced; improved response and survival rate were observed in some prospective randomized control trials (5)(6)(7)(8). However, different from systemic chemotherapy, IPHC is a time-limited modality with relatively high-dose of anticancer drugs.…”

Survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer: a systematic review

“…5-years survival rate ranged from 6% to 31%. In the 3 case control studies that used surgery only as the comparative group, overall survival in the HIPEC group was better than that in the control group [24][25][26]. This was statistically significant.…”

“…Since then, various Asian groups have gone on to investigate the use of HIPEC in the prophylactic setting [21,25,26,[83][84][85][86][87]. All of them have provided evidence to show that HIPEC in the prophylactic setting can reduce the incidence of peritoneal recurrence and improve survival.…”

“…The abstracts of these 145 articles were reviewed carefully and a further 42 articles had full text review. Ultimately, 17 articles were included in this review and summarized in Table 1 [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Of the 17 articles included in the review, 1 was a systematic review, 1 was a randomized controlled trial, 11 were prospective studies (7 case series, 4 case controls and 1 prospective randomized trial) and the remaining 4 were retrospective studies.…”

“…The completeness of cytoreduction was found to be a prognostic factor in 11 studies [26][27][28][29][30][31][32][33][35][36][37]. Glehen et al showed in 2004 that with a CC score of 0 or 1, the median overall survival improved from 10.3 months to 21.3 months [27].…”