Methasate Asada, Parakonthun Thammawat, Intralawan Thita, Nampoolsuksan Chawisa, Swangsri Jirawat
Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Upper Gastrointestinal Cancer Center, Siriraj Hospital Mahidol University, Bangkok 10700, Thailand.
World J Clin Oncol. 2024 Jul 24;15(7):840-847. doi: 10.5306/wjco.v15.i7.840.
Gastric cancer presenting with peritoneal metastasis is notably associated with diminished survival prospects. The use of cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to increase survival rates in these patients. Despite these advancements, debates persist regarding the magnitude of survival improvement attributed to this treatment modality. The present investigation examined survival outcomes following HIPEC in individuals diagnosed with gastric cancer and peritoneal metastasis, and it took a comparative analysis of patients exhibiting positive and negative cytological findings.
To compare the impact of HIPEC on survival in gastric cancer patients with peritoneal metastasis and positive or negative cytology.
Between April 2013 and March 2020, 84 patients with advanced gastric cancer treated at our institution were categorized into three cohorts: HIPEC (20 patients with peritoneal metastasis), cytology-positive (23 patients without peritoneal nodules but with positive wash cytology), and cytology-negative (41 patients with advanced gastric cancer, no peritoneal nodules, and negative wash cytology). The HIPEC cohort underwent gastrectomy with HIPEC, while the cytology-positive and cytology-negative groups received gastrectomy alone. The demographic, pathological, and survival data of the groups were compared.
The HIPEC cohort-predominantly younger females-exhibited relatively extended surgical durations and high blood loss. Nevertheless, the complication rates were consistent across all three groups. Median survival in the HIPEC group was 20.00 ± 4.89 months, with 1-year, 2-year, and 3-year overall survival rates of 73.90%, 28.70%, and 9.60%, respectively. These figures paralleled the survival rates of the cytology-positive group (52.20% at 1 year, 28.50% at 2 years, and 19.00% at 3 years). Notably, 47% of patients experienced peritoneal recurrence.
HIPEC may offer a modest improvement in short-term survival for patients with gastric cancer and peritoneal metastasis, mirroring the outcomes in cytology-positive patients. However, peritoneal recurrence remained high.
出现腹膜转移的胃癌显著影响生存前景。细胞减灭术联合热灌注化疗（HIPEC）已被证明可提高这些患者的生存率。尽管有这些进展，但对于这种治疗方式所带来的生存改善程度仍存在争议。本研究调查了诊断为胃癌并伴有腹膜转移的患者接受HIPEC后的生存结果，并对细胞学检查结果为阳性和阴性的患者进行了对比分析。
比较HIPEC对伴有腹膜转移且细胞学检查为阳性或阴性的胃癌患者生存的影响。
2013年4月至2020年3月期间，在我院接受治疗的84例晚期胃癌患者被分为三组：HIPEC组（20例有腹膜转移的患者）、细胞学阳性组（23例无腹膜结节但冲洗液细胞学检查为阳性的患者）和细胞学阴性组（41例晚期胃癌患者，无腹膜结节且冲洗液细胞学检查为阴性）。HIPEC组接受了胃癌切除术联合HIPEC，而细胞学阳性组和细胞学阴性组仅接受了胃癌切除术。比较了三组的人口统计学、病理学和生存数据。
HIPEC组以年轻女性为主，手术时间相对较长，失血量较多。然而，三组的并发症发生率一致。HIPEC组的中位生存期为20.00±4.89个月，1年、2年和3年总生存率分别为73.90%、28.70%和9.60%。这些数据与细胞学阳性组的生存率相似（1年时为52.20%，2年时为28.50%，3年时为19.00%）。值得注意的是，47%的患者出现了腹膜复发。
HIPEC可能会使伴有腹膜转移的胃癌患者的短期生存略有改善，与细胞学阳性患者的结果相似。然而，腹膜复发率仍然很高。
