title: Aggressive locoregional surgical therapy for gastric peritoneal carcinomatosis.
abstract: BACKGROUND
  Peritoneal carcinomatosis from gastric cancer (GPC) responds poorly to systemic chemotherapy. Limited published data demonstrate improved outcomes after aggressive locoregional therapies. We assessed the efficacy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) in GPC.
  
  
  METHODS
  We prospectively analyzed 23 patients with GPC undergoing CRS/HIPEC between 2001 and 2010. Kaplan-Meier survival curves and multivariate Cox regression models identified prognostic factors affecting oncologic outcomes.
  
  
  RESULTS
  CRS/HIPEC was performed for synchronous GPC in 20 patients and metachronous GPC in 3 patients. Adequate CRS was achieved in 22 patients (CC-0 = 17; CC-1 = 5) and median peritoneal cancer index was 10.5. Most patients received preoperative chemotherapy (83 %) and total gastrectomy (78 %). Pathology revealed diffuse histology (65 %), signet cells (65 %) and LN involvement (64 %). Major postoperative morbidity occurred in 12 patients, with 1 in-hospital mortality at postoperative day 66. With median follow-up of 52 months, median overall survival (OS) was 9.5 months (95 % confidence interval 4.7-17.3), with 1- and 3- year OS rates of 50 and 18 %. Median progression-free survival (PFS) was 6.8 months (95 % confidence interval 3.9-14.6). In a multivariate Cox regression model, male gender [hazard ratio (HR) 6.3], LN involvement (HR 1.2), residual tumor nodules (HR 2.4), and >2 anastomoses (HR 2.8) were joint significant predictors of poor OS (χ (2) = 18.2, p = 0.001), while signet cells (HR 8.9), anastomoses >2 (HR 5.5), and male gender (HR 2.4) were joint significant predictors of poor progression (χ (2) = 16.3, p = 0.001).
  
  
  CONCLUSIONS
  Aggressive CRS/HIPEC for GPC may confer a survival benefit in select patients with limited lymph node involvement and completely resectable disease requiring less extensive visceral resections.
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Deepa
authors.initials: D
authors.lastname: Magge
authors.forename: Mazen
authors.initials: M
authors.lastname: Zenati
authors.forename: Arun
authors.initials: A
authors.lastname: Mavanur
authors.forename: Joshua
authors.initials: J
authors.lastname: Winer
authors.forename: Lekshmi
authors.initials: L
authors.lastname: Ramalingam
authors.forename: Heather
authors.initials: H
authors.lastname: Jones
authors.forename: Amer
authors.initials: A
authors.lastname: Zureikat
authors.forename: Matthew
authors.initials: M
authors.lastname: Holtzman
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lee
authors.forename: Steven
authors.initials: S
authors.lastname: Ahrendt
authors.forename: James
authors.initials: J
authors.lastname: Pingpank
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
authors.forename: David L
authors.initials: DL
authors.lastname: Bartlett
authors.forename: Haroon A
authors.initials: HA
authors.lastname: Choudry
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate