with Dr. Borja De Lacy
Peritoneal carcinomatosis is a significant problem in gastric cancer, with an incidence rate that ranges between 5 and 20%. What is consistent among studies and registries is the poor prognosis of these patients: 5-year overall survival lower than 3%, median survival of 3-4 months in patients with carcinomatosis and no treatment, which increases to about 6-13 months when systemic chemotherapy is given.
A systematic review and meta-analysis of RCTs concluded that surgery and HIPEC significantly improved overall survival at 1, 2 and 3 years, besides decreasing the overall recurrence rate. Moreover, the CYTOCHIP study, an observational cohort study that used the inverse probability of treatment weight method to manage confounding and selection bias, showed an estimation of the causal treatment effect of HIPEC on survival, with a significant improvement in overall survival without increased morbidity or short-term mortality. As in all patients with peritoneal carcinomatosis regardless of origin, the key to success is an appropriate selection of the candidates for CRS and HIPEC. Age and general status are major factors, and in gastric carcinomatosis it seems that PCI scores should be lower than 7-10. Besides, complete cytoreduction must be achieved. In those strictly selected patients, it seems that gastrectomy and CRS + HIPEC increases survival, at least from Asian RCTs and well-designed observational European studies. This is summarized in the updated Chicago Consensus on Peritoneal Surface Malignancies, which will also be presented in the video. Nevertheless, before drawing firm and definitive conclusions, more clinical trials are required.
This video will review the evidence-based research on cytoreductive surgery and HIPEC in peritoneal carcinomatosis from gastric origin. The role of staging laparoscopy and the most important ongoing trials will also be discussed.
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