title: Intraperitoneal chemotherapy in advanced gastric cancer. Meta-analysis of randomized trials.
abstract: BACKGROUND
  An important component of treatment failure in gastric cancer (GC) is cancer dissemination within the peritoneal cavity and nodal metastasis. Intraperitoneal chemotherapy (IPC) is considered to give a fundamental contribute in treating advanced GC. The purpose of the study is to investigate the effects of IPC in patients with advanced GC.
  
  
  METHODS
  A systematic review with meta-analysis of randomized controlled trials (RCTs) of IPC + surgery vs. control in patients with advanced GC was performed.
  
  
  RESULTS
  Twenty prospective RCTs have been included (2145 patients: 1152 into surgery + IPC arm and 993 into control arm). Surgery + IPC improves: 1, 2 and 3-year mortality (OR = 0.31, 0.27, 0.29 respectively), 2 and 3-year mortality in patients with loco-regional nodal metastasis (OR = 0.28, 0.16 respectively), 1 and 2-year mortality rate in patients with serosal infiltration (OR = 0.33, 0.27 respectively). Morbidity rate was increased by surgery + IPC (OR = 1.82). The overall recurrence and the peritoneal recurrence rates were improved by surgery + IPC (OR = 0.46 and 0.47 respectively). There was no statistically significant difference in lymph-nodal recurrence rate. The rate of haematogenous metastasis was improved by surgery + IPC (OR = 0.63).
  
  
  CONCLUSIONS
  1, 2 and 3-year overall survival is incremented by the IPC. No differences have been found at 5-year in overall survival rate. 2 and 3-year mortality rates in patients with nodal invasion and 1 and 2-year mortality rates in patients with serosal infiltration are improved by the use of IPC. IPC has positive effect on peritoneal recurrence and distant metastasis. Morbidity rate is incremented by IPC. Loco-regional lymph-nodes invasion in patients affected by advanced gastric cancer is not a contraindication to IPC.
authors.affiliation: General Surgery Dept., Papa Giovanni XXIII Hospital, Bergamo, Italy; General Surgery Dept., Centre Hospitalier Lyon Sud, Hospices Civils de Lyon and EMR 3738, Université Lyon 1, France. Electronic address: federico.coccolini@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Coccolini
authors.affiliation: General Surgery Dept., Centre Hospitalier Lyon Sud, Hospices Civils de Lyon and EMR 3738, Université Lyon 1, France.
authors.forename: E
authors.initials: E
authors.lastname: Cotte
authors.affiliation: General Surgery Dept., Centre Hospitalier Lyon Sud, Hospices Civils de Lyon and EMR 3738, Université Lyon 1, France.
authors.forename: O
authors.initials: O
authors.lastname: Glehen
authors.affiliation: General Surgery Dept., Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Lotti
authors.affiliation: General Surgery Dept., Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Poiasina
authors.affiliation: General Surgery Dept., Ospedale Maggiore, Parma, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Catena
authors.affiliation: General Surgery Dept., Kusatsu General Hospital, Yabase 1660, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yonemura
authors.affiliation: General Surgery Dept., Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Ansaloni
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D006801:Humans; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D010529:Peritoneal Cavity; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D015983:Selection Bias; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate
keywords: Carcinosis; Gastric cancer; HIPEC; Intraperitoneal chemotherapy; Meta-analysis; Nodal infiltration