Gastric cancer with limited peritoneal metastasis: Role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Background and objectives: Peritoneal metastasis in gastric cancer is associated with a very poor prognosis with a median overall survival of seven to 15 months if treated with systemic chemotherapy only. Studies have shown improved survival with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in selected group of patients, when compared to systemic chemotherapy alone. In spite of promising results, this is not the standard of care till date. The aim of our study was to evaluate the long-term outcome for the patients of gastric cancer with peritoneal metastases undergoing cytoreductive surgery and HIPEC at our institute.

Methods: Retrospective analysis of prospectively maintained data of all patients, who underwent cytoreductive surgery and HIPEC during the period of 2015-2023, was performed. All relevant pre-operative, peri-operative, post-operative and histopathological data was analyzed and overall survival and disease-free survival calculated.

Results: Twenty-three patients of gastric cancer with peritoneal metastasis (PCI < / = 7) underwent cytoreductive surgery and HIPEC during the study period. At a median follow-up of 12 months, median disease-free survival (DFS) and overall survival (OS) were 12 months and 35 months, respectively. One-year and three-year DFS were 48.5% and 23%, respectively. One-year and three-year OS was 85% and 45.4%, respectively.

Conclusion: Cytoreductive surgery and HIPEC can be considered to be safe and effective treatment strategy in a select group of gastric cancer patients with peritoneal metastasis leading to a meaningful survival as compared to palliative systemic chemotherapy.