Prophylaxis and treatment of peritoneal carcinomatosis of gastric origin using hyperthermic intraperitoneal chemotherapy: a Systematic Review and Meta-Analysis of randomized trials

BACKGROUND

Peritoneal carcinomatosis significantly worsens the prognosis of gastric cancer patients. Cytoreduction + HIPEC has shown promising results in the prevention and treatment of peritoneal carcinomatosis in advanced gastric cancer; however, its application remains controversial owing to the variability of the approaches used to perform it and the lack of high-quality evidence. This systematic review and meta-analysis aimed to investigate the role of surgery and HIPEC in the prevention and treatment of peritoneal carcinomatosis of gastric origin.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials comparing surgery + HIPEC vs. surgery + chemotherapy for the prophylaxis of peritoneal carcinomatosis and cytoreduction + HIPEC vs. chemotherapy or other palliative options for the treatment of peritoneal carcinomatosis.

RESULTS

Sixteen studies enrolling 1641 patients were included. Surgery + HIPEC significantly improved overall survival in both prophylactic (HR = 0.56) and therapeutic (HR = 0.57) settings. When surgery + HIPEC was performed with prophylactic intent, the pooled 3-year mortality rate was 32%, while for the control group, it was 55%. The overall and peritoneal recurrence rates were also reduced (RR = 0.59 and 0.40 respectively). No significant difference was found in morbidity between groups (RR = 0.92).

CONCLUSIONS

Based on the current knowledge, HIPEC in AGC appears to be a safe and effective tool for prophylaxis and a promising resource for the treatment of peritoneal carcinomatosis. Regarding the treatment of peritoneal carcinomatosis, the scarcity of large-cohort studies and the heterogeneity of the techniques adopted prevented us from achieving a definitive recommendation.