Laparoscopic HIPEC for Low-Volume Peritoneal Metastasis in Gastric and Gastroesophageal Adenocarcinoma.
Adenocarcinoma
/ therapy
Aged
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Chemotherapy, Cancer, Regional Perfusion
Cytoreduction Surgical Procedures
Female
Humans
Hyperthermic Intraperitoneal Chemotherapy
Laparoscopy
Male
Middle Aged
Percutaneous Coronary Intervention
Peritoneal Neoplasms
/ therapy
Stomach
Survival Rate
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
02
03
2020
accepted:
21
07
2020
pubmed:
2
8
2020
medline:
6
5
2021
entrez:
2
8
2020
Statut:
ppublish
Résumé
We seek to determine whether laparoscopic hyperthermic intraperitoneal chemoperfusion (LS-HIPEC) improves overall survival (OS) in patients with gastric and gastroesophageal adenocarcinoma and low-volume peritoneal metastasis compared with standard of care treatment. We reviewed data from a prospectively maintained database of patients with gastric and gastroesophageal adenocarcinoma to identify patients with radiologically occult carcinomatosis or positive peritoneal cytology, no evidence of distant metastasis, and without disease progression during initial chemotherapy or observation. Univariate and multivariable analyses were performed to evaluate the impact of LS-HIPEC on OS. We identified 25 patients who underwent LS-HIPEC and 27 treated with a standard of care approach due to patient (33.3%) or provider (51.9%) preference or financial limitations/lack of insurance coverage (14.8%). Resection was ultimately performed in 28% of LS-HIPEC patients and no standard care patients. At a median follow-up of 18.9 months, median OS was 24.7 (IQR 20.8-34.2) months in LS-HIPEC patients and 21.3 (IQR 12.3-23.1) months in standard care patients (p = 0.08). Three-year OS in the LS-HIPEC group was 19.1%, compared with 9.6% (p = 0.08). Patients who underwent resection had a median OS of 25.3 (IQR 22.6-47.1) months compared with 21.3 months in standard care patients (p = 0.05). Neoadjuvant LS-HIPEC for the treatment of low-volume peritoneal disease in gastric and gastroesophageal cancer patients did not significantly improve OS compared with standard care. Multiinstitutional studies are necessary to further elucidate the benefit of LS-HIPEC for this patient population.
Sections du résumé
BACKGROUND
BACKGROUND
We seek to determine whether laparoscopic hyperthermic intraperitoneal chemoperfusion (LS-HIPEC) improves overall survival (OS) in patients with gastric and gastroesophageal adenocarcinoma and low-volume peritoneal metastasis compared with standard of care treatment.
PATIENTS AND METHODS
METHODS
We reviewed data from a prospectively maintained database of patients with gastric and gastroesophageal adenocarcinoma to identify patients with radiologically occult carcinomatosis or positive peritoneal cytology, no evidence of distant metastasis, and without disease progression during initial chemotherapy or observation. Univariate and multivariable analyses were performed to evaluate the impact of LS-HIPEC on OS.
RESULTS
RESULTS
We identified 25 patients who underwent LS-HIPEC and 27 treated with a standard of care approach due to patient (33.3%) or provider (51.9%) preference or financial limitations/lack of insurance coverage (14.8%). Resection was ultimately performed in 28% of LS-HIPEC patients and no standard care patients. At a median follow-up of 18.9 months, median OS was 24.7 (IQR 20.8-34.2) months in LS-HIPEC patients and 21.3 (IQR 12.3-23.1) months in standard care patients (p = 0.08). Three-year OS in the LS-HIPEC group was 19.1%, compared with 9.6% (p = 0.08). Patients who underwent resection had a median OS of 25.3 (IQR 22.6-47.1) months compared with 21.3 months in standard care patients (p = 0.05).
CONCLUSIONS
CONCLUSIONS
Neoadjuvant LS-HIPEC for the treatment of low-volume peritoneal disease in gastric and gastroesophageal cancer patients did not significantly improve OS compared with standard care. Multiinstitutional studies are necessary to further elucidate the benefit of LS-HIPEC for this patient population.
Identifiants
pubmed: 32737700
doi: 10.1245/s10434-020-08968-8
pii: 10.1245/s10434-020-08968-8
pmc: PMC7682939
mid: NIHMS1644043
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5047-5056Subventions
Organisme : NCI NIH HHS
ID : P30 CA016672
Pays : United States
Organisme : Holly Clegg Gastric Cancer Research Fund
ID : No Stomach for Cancer Award for Gastric Cancer Res
Organisme : NCI NIH HHS
ID : T32 CA009599
Pays : United States
Organisme : University of Texas MD Anderson Cancer Center
ID : Support grant P30 CA016672
Organisme : NIH HHS
ID : T32 CA 009599
Pays : United States
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