Conversion surgery for stage IV gastric cancer with peritoneal carcinomatosis

14:00-14:20, Room 101 (101講堂)

Speaker

Professor

De-Chuan Chan

MD, PhD

詹德全 教授

Chairman, Department of Surgery, Tri-Service General Hospital

Moderator

Professor

Ming-Tsain Lin

MD, PhD

林明燦 教授

Department of Surgery, National Taiwan University Hospital

Abstract - 

Conversion surgery for stage IV gastric cancer with peritoneal carcinomatosis

BACKGOUND

Patients with advanced gastric cancer with peritoneal carcinomatosis (AGC with PC) usually have poor outcomes and a high mortality risk, even with cytoreductive surgery (CRS) plus HIPEC (hyperthermic intraperitoneal chemotherapy). This study analyzed the prognostic factors of AGC with PC and evaluated laparoscopic HIPEC (LHIPEC) plus neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) as a conversion surgery for AGC patients with PC with a poor initial prognosis.

PATIENT AND METHODS

We retrospectively evaluated 127 patients with AGC and PC from January 1, 2012 to March 1, 2020. After exclusion of 32 ineligible patients, the conversion group comprised 34 patients who underwent LHIPEC+NIPS as a conversion surgery followed by CRS plus HIPEC. CRS+HIPEC group included 15 patients who underwent CRS with HIPEC alone. Additionally, the C/T group comprised 23 patients who received systemic chemotherapy and the palliative group comprised 23 patients who received only conservative therapy or palliative gastrectomy.

 

RESULT

The conversion group demonstrated a significantly better mean overall survival compared to the CRS+HIPEC alone, C/T, and palliative groups (p < 0.001). Patients in the conversion group who underwent LHIPEC+NIPS had significantly decreased PCI (peritoneal cancer index) scores (p < 0.001) and ascites amount (p = 0.003). Malignant ascites also significantly decreased after treatment in the LHIPEC+NIPS group (p < 0.001).

Conclusions: LHIPEC+NIPS can significantly improve the overall survival, PCI score, and malignant ascites in peritoneal cytology positive gastric cancer with PC and an initially high PCI score. Therefore, it may be a feasible conversion strategy for patients with AGC with PC.