Neoadjuvant Laparoscopic HIPEC combined with Neoadjuvant Chemotherapy followed by Surgery plus intraoperative HIPEC for Advanced Gastric Cancer at risk of Peritoneal Carcinomatosis: feasibility and safety assessment from retrospective case control study

Abstract

Objective: In this study we have retrospectively evaluated the feasibility and safety of a novel therapeutic regimen for the management of Advanced Gastric Cancer (AGC) at risk for peritoneal carcinomatosis (PC) involving neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy (NLHIPEC) and neoadjuvant chemotherapy (NAC).Methods: From December 2017 to June 2018, 7 AGC patients undergoing NLHIPEC + NAC + Surgery+ Intraoperative HIPEC + adjuvant chemotherapy (AC) were included in the study and observed for associated complication and morbidity. AGC patients undergoing other neoadjuvant and prophylactic treatment approaches were retrospectively analyzed and case-matched. Intraoperative and post-operative events, clinical recovery and morbidity were closely monitored till 1 month after the last cycle of chemotherapy.Results: Of a total of 328 AGC patients undergoing curative surgery, 7 other patients undergoing NAC + HIPEC, 7 patients undergoing surgery + HIPEC and 17 patients undergoing NAC were retrospectively included. There was no 30-day post-operative mortality recorded in the 4 groups. In total, 14 events were recorded and 5/14 of the complications were rated as Clavien I; 8/14 patients were classified as Clavien II and 1/14 patient was recorded as Clavien grade IIIa. There was no grade IIIb-V event. The results suggest that the proposed treatment regimen is safe and feasible.Conclusions: This combination of NLHIPEC and NAC in the management of AGC at high risk for peritoneal involvement is feasible, safe, well-tolerated and worth exploring.