Prognostic Factors in Gastric Cancer Patients with Peritoneal Carcinomatosis

Abstract

Purpose: Peritoneal carcinomatosis (PC) has a dismal prognosis and is occasionally encountered during initial exploration in patients with gastric cancer. The clinicopathological characteristics and survival were analyzed in patients with gastric cancer and PC. Materials and Methods: Among 2,083 gastric cancer patients who received surgery at the department of surgery, Hanyang University Hospital from 1992 to 2009, 130 patients revealed PC. Ten patients who were lost during follow-up were excluded. The remaining 120 patients were divided into three groups according to the type of surgery. The degree of PC was classified into P1(to the adjacent peritoneum) and P2 (to the distant peritoneum). Various other clinicopathological factors were analyzed using univariate and multivariate survival analyses. Results: Systemic chemotherapy (SC), type of surgery, lymph node dissection, degree of PC, and presence of ascites were significant prognostic factors. However, age, gender, resection of PC, and Borrmann type were not significant prognostic factors. In a multivariate analysis, SC and the degree of PC were independent prognostic factors. The survival benefit of SC was significant without reference to the type of surgery or degree of PC. Conclusions: A gastrectomy should be considered feasible in patients with gastric cancer and PC. The independent favorable prognostic factors were SC and a low degree of PC. SC improved the prognosis regardless of operation type and degree of PC.

The Result of Conversion Surgery in Gastric Cancer Patients with Peritoneal Seeding

“… 9 , 10 , 11 , 12 Performing gastrectomy in patients with gastric cancer and peritoneal seeding has reported to increase response to chemotherapy and subsequently, improves patient prognosis. 9 , 13 , 14 The present study compared the clinicopathologic characteristics and prognosis of patients according to gastrectomy after conventional chemotherapy (conversion therapy) and showed that clinically curative conversion therapy resulted in the best survival rate and prognosis, and that patients who underwent non-curative resected showed better outcomes than those who had continued chemotherapy.…”

Clinical Outcomes according to Primary Treatment in Gastric Cancer Patients with Peritoneal Seeding

“…( 10 , 14 - 16 ) Furthermore, gastrectomy in the gastric cancer with peritoneal seeding is known to increase the response of chemotherapy, subsequently, improved prognosis. ( 10 - 12 ) Therefore, the authors compared the clinical characteristics and the prognosis according to primary treatments of gastric cancer with peritoneal seeding. Laparoscopy made easy for us to decide the treatment method because it made possible to find out about the level of peritoneal seeding precisely without unnecessary laparotomy when peritoneal seeding is suspected.…”

“…( 8 , 9 ) The research findings are continuously shown that when primary gastrectomy was performed actively prior to chemotherapy, the response to the chemotherapy increased and resulted in the improved prognosis. ( 10 - 12 ) Therefore, the careful consideration is required to choose a treatment option between primary chemotherapy and primary gastrectomy. Although the status of the disease at the time of diagnosis is an important variable to make a decision, the clinical outcomes of each treatment can be also considered when the decision is made.…”