Prophylactic HIPEC with radical D2 gastrectomy improves survival and peritoneal recurrence rates for locally advanced gastric cancer: personal experience from a randomized case control study

Abstract

Background To investigate the implications of prophylactic intraoperative Hyperthermic Intraperitoneal Chemotherapy (HIPEC) with D2 radical gastrectomy for locally advanced Gastric Cancer (AGC) in a randomized case control study. Method Eighty consecutive patients with locally AGC were randomly separated into 2 groups: HIPEC group (Curative Resection + intraoperative HIPEC with cisplatin 50 mg/m2 at 42.0 ± 1.0 °C for 60 min) and Control group (Curative Resection only). Intraoperative and post-operative events, clinical recovery, morbidity and the disease-free survival (DFS) rates were closely monitored. Results Faster recovery of bowel function (43 ± 5 h vs 68 ± 7, P < 0.05) and shorter postoperative stay (8d vs 14d, P < 0.05) were noted in the HIPEC group. Among the 40 HIPEC group patients, the highest intracranial temperature recorded during the procedure was 38.2 °C but the patient made an eventless recovery. Mild renal dysfunction, hyperbilirubinemia and mild liver dysfunction were recorded in the HIPEC group but their incidences were found to be statistically insignificant when compared with the control group (P > 0.05). The 3 year DFS rate analysis showed that the prophylactic HIPEC group had a higher DFS rate (93% vs 65%, P = 0.0054). The peritoneal recurrence rate was lower in the HIPEC group (3% vs 23%, P < 0.05). Conclusion Prophylactic HIPEC with radical D2 Gastrectomy improves survival and peritoneal recurrence rates for AGC with favorable post-operative recovery at low and acceptable morbidity.

Role of prophylactic hyperthermic intraperitoneal chemotherapy in patients with locally advanced gastric cancer

“…Previous findings suggest that the use of cytoreductive surgery plus HIPEC increases the risks of postoperative anastomotic leakage, intestinal fistula development, and abdominal bleeding[ 16 ]. However, in this study, the incidence of complications did not differ significantly between groups.…”

Does hipec improve outcomes in gastric cancer patients treated with perioperative chemotherapy and radical surgery? A propensity‐score matched analysis

“…To improve these recurrence rates, since 1988 several local treatment modalities have been studied for better local control and improved survival, such as HIPEC and more recently the extensive intraoperative peritoneal lavage with physiological saline . Evidence from earlier and recent trials along with at least three metanalysis suggests a survival benefit of adding HIPEC to a curative surgical procedure. What our study meant to investigate was if the same impact would be found in patients who were already treated with neoadjuvant chemotherapy, as it is now part of the standard multimodality therapy for gastric cancer …”

“…16 To improve these recurrence rates, since 1988 several local treatment modalities have been studied for better local control and improved survival, such as HIPEC 17 and more recently the extensive intraoperative peritoneal lavage with physiological saline. 18 Evidence from earlier 3,19 and recent trials 20,21 along with at least three metanalysis 4,5,22 suggests a survival benefit of adding HIPEC to a curative surgical procedure.…”

Optimization of perioperative approaches for advanced and late stages of gastric cancer: clinical proposal based on literature evidence, personal experience, and ongoing trials and research

“…In a study by Cui et al, where 192 AGC patients were randomly divided into the following four groups (control, NAC, HIPEC and combined groups), the results suggested that NAC combined with HIPEC for the treatment of AGC is well tolerated and exhibits improved compliance and efficiency [32]. In another study from our team, with a pool of 80 patients with 40 patients undergoing prophylactic HIPEC while the control group had surgery alone, the results showed that the experimental arm had significant survival benefit with a decrease in peritoneal metastatic rate [33].…”