Ann Surg Treat Res.  2021 Apr;100(4):209-217. 10.4174/astr.2021.100.4.209.

Treatment options for advanced gastric cancer with peritoneal metastasis: experience from a single institution in Korea

• Kim DW
• Youn SI
• Jee YS

• KMID: 2514718
• DOI: http://doi.org/10.4174/astr.2021.100.4.209

Abstract

Purpose
This study aimed to compare treatment options and outcomes based on peritoneal cancer index (PCI) among patients with peritoneal metastasis (PM) of advanced gastric cancer (AGC).
Methods
Between January 2016 and July 2019, clinicopathological data of patients with AGC diagnosed with PM were reviewed. Different treatment methods were performed according to the PCI score: (1) group A (PCI ≤ 13) received cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with postoperative intraperitoneal (IP) and systemic chemotherapy (n = 29), while (2) group B (PCI > 13) received IP chemotherapy with systemic chemotherapy (n = 22).
Results
Clinical outcomes of 51 patients at the Dankook University Hospital were reviewed. Group A had a significantly lower mean PCI score (9.8 ± 6.9 vs. 32.6 ± 7.1, P < 0.01) than group B, with 25 patients (86.2%) achieving complete cytoreduction. Complications occurred in 16 patients (31.4%), none of who suffered mortality (group A: 11 patients, 37.9% vs. group B: 5 patients, 22.7%; P = 0.25). Among the morbidity, 5 cases (17.2%) and 2 cases (9.1%) exhibited a Clavien-Dindo grade greater than III in groups A and B, respectively (P = 0.04). Groups A and B had an overall median survival time of 34.0 and 16.0 months, respectively (P = 0.03).
Conclusion
Patients with PM of AGC received different treatments according to their PCI score. When accompanied with careful patient selection, our approach may be considered an acceptable option for the treatment of PM of AGC.

Keyword

Advanced gastric cancer; Cytoreduction surgical procedures; Peritoneal metastasis

Figure

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  Fig. 1 Treatment strategy for advanced gastric cancer (AGC) with peritoneal metastasis (PM) in Dankook University Hospital. PCI, peritoneal cancer index; CRS, cytoreductive surgery; HIPEC, hyperthermic intraperitoneal chemotherapy; IP, intraperitoneal.

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  Fig. 2 Comparison of patient information regarding cytoreductive surgery and hyperthermic intraperitoneal chemotherapy before and after 2016. PCI, peritoneal cancer index; CD, Clavien-Dindo.

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  Fig. 3 Overall survival (A) and progression free survival (B) according to treatment type (34.0 months vs. 16.0 months, P = 0.03; 23.0 months vs. 11.0 months, P = 0.01).

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  Fig. 4 Overall survival according to the completeness of cytoreduction (CCR) (0–1, 36.0 months and 2–3, 17.0 months; P = 0.03).

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