title: Hyperthermic intraperitoneal chemotherapy (HIPEC) and neoadjuvant chemotherapy as prophylaxis of peritoneal carcinosis from advanced gastric cancer-effects on overall and disease free survival.
abstract: BACKGROUND
  The possibility to enlarge criteria for intra-peritoneal chemotherapy (IPC) to all patients at high-risk to develop peritoneal carcinosis (i.e., with serosal invasion) is still discussed.
  
  
  METHODS
  Retrospective case-control study. Three-groups: advanced-gastric-cancer (AGC) (pT4) without proven carcinosis: prophylactic group (PG), those with PC: treatment group (TG), AGC (pT3-pT4) operated without hyperthermic intraperitoneal chemotherapy (HIPEC), surgery alone group (SG T3, SG T4).
  
  
  RESULTS
  Forty four patients. 26 (59.1%) were male. Sixteen (36%) patients underwent 16 HIPEC: 6 (38%) had AGC (pT4) without PC (PG), 10 (62%) had carcinosis (TG), 28 were operated without HIPEC (SG T3, SG T4). The mean disease free survival (DFS): TG: 7.7 months, SG T4: 21.6 months, SG T3: 27.7 months, PG: 34.5 months. DFS was significantly different for TG (P=0.03, P=0.021, P=0.013 respectively). The mean OS TG: 10 months, SG T4: 27.1 months, SG T3: 28.2 months, PG: 34.6 months. OS was significantly different for TG (P=0.04, P=0.04, P=0.045 respectively). Severe complication rate: TG: 60%, PG: 16.7%, SG T3: 7.7% and SG T4: 25% (P=0.035). Length-of-stay differs significantly (P=0.003); overall length-of-stay: 19.41 days [standard deviation (SD) ±15.03]; TG: 33.01 (SD ±23.08), PG: 20.17 (SD ±6.21), SG T3: 11.33 (SD ±3.22), SG T4: 15.36 (SD ±5.48).
  
  
  CONCLUSIONS
  Prophylactic intraperitoneal chemotherapy associated to neoadjuvant chemotherapy increases the DFS and OS in patients with AGC without carcinosis. More data are needed in order to confirm these results.
authors: General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy ;
authors: Federico
authors: F
authors: Coccolini
authors: General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy ;
authors: Andrea
authors: A
authors: Celotti
authors: General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy ;
authors: Marco
authors: M
authors: Ceresoli
authors: General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy ;
authors: Giulia
authors: G
authors: Montori
authors: General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy ;
authors: Michele
authors: M
authors: Marini
authors: General and Emergency surgery, Parma Maggiore Hospital, Parma, Italy.
authors: Fausto
authors: F
authors: Catena
authors: General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy ;
authors: Luca
authors: L
authors: Ansaloni
keywords: Gastric cancer; carcinosis; hyperthermic intraperitoneal chemotherapy (HIPEC); intraperitoneal chemotherapy; prevention; prophylaxis; treatment