Stefano Granieri1, Alessandro Bonomi2, Simone Frassini3, Andrea Piero Chierici4, Federica Bruno5, Sissi Paleino6, Shigeki Kusamura7, Alessandro Germini8, Antonio Facciorusso9, Marcello Deraco10, Christian Cotsoglou11. 1. General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy. Electronic address: stefano.granieri@asst-brianza.it. 2. University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; General Surgery Unit, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy. Electronic address: alessandro.bonomi@unimi.it. 3. University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy; General Surgery Unit, Department of Surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy. Electronic address: simone.frassini01@universitadipavia.it. 4. University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy. Electronic address: andrea.chierici@unimi.it. 5. General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy. Electronic address: federica.bruno@asst-brianza.it. 6. University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy. Electronic address: sissi.paleino@unimi.it. 7. Peritoneal Surface Malignancies Unit, Fondazione I.R.C.C.S., Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy. Electronic address: shigeki.kusamura@istitutotumori.mi.it. 8. General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy. Electronic address: alessandro.germini@asst-brianza.it. 9. Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Viale Luigi Pinto, 1, 71122, Foggia, Italy. Electronic address: antonio.facciorusso@virgilio.it. 10. Peritoneal Surface Malignancies Unit, Fondazione I.R.C.C.S., Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy. Electronic address: marcello.deraco@istitutotumori.mi.it. 11. General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy. Electronic address: christian.cotsoglou@asst-brianza.it.
Abstract
BACKGROUND: gastric cancer patients frequently develop peritoneal metastases (PM) with a poor long-term prognosis. A solid body of evidence underlines the beneficial role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on survival, but to date, there is a lack of consensus regarding the optimal strategy in the treatment of locally advanced primary tumors with or without peritoneal metastasis. The present meta-analysis aims to assess the impact of CRS + HIPEC on survival analyzing the results of randomized studies only. METHODS: A systematic review of articles was conducted according to PRISMA guidelines. Twelve studies were included in qualitative and quantitative analysis. RESULTS: A survival benefit for patients treated with CRS + HIPEC at all time points was highlighted. However, difference in survival was significant at all time points for patients treated for prophylaxis of PM, but no difference was found when considering resection with a curative intent. The 1, 2, 3 and 5-year survival rates (SR) for patients undergoing CRS + HIPEC were 86.9%, 70.5%, 63.7% and 55.7% respectively. CRS + HIPEC for the treatment rather than prophylaxis of PM was the only predictor of a reduced 3y SR. CONCLUSIONS: CRS + HIPEC may lead to improved prognosis for patients suffering from locally advanced gastric cancer in both prophylactic and curative settings. However, due to far from negligible postoperative morbidity and mortality rates, a strict patient selection is crucial to achieve the best results. The presence of extraperitoneal disease strongly limits the indication of this kind of surgery.
BACKGROUND: gastric cancer patients frequently develop peritoneal metastases (PM) with a poor long-term prognosis. A solid body of evidence underlines the beneficial role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) on survival, but to date, there is a lack of consensus regarding the optimal strategy in the treatment of locally advanced primary tumors with or without peritoneal metastasis. The present meta-analysis aims to assess the impact of CRS + HIPEC on survival analyzing the results of randomized studies only. METHODS: A systematic review of articles was conducted according to PRISMA guidelines. Twelve studies were included in qualitative and quantitative analysis. RESULTS: A survival benefit for patients treated with CRS + HIPEC at all time points was highlighted. However, difference in survival was significant at all time points for patients treated for prophylaxis of PM, but no difference was found when considering resection with a curative intent. The 1, 2, 3 and 5-year survival rates (SR) for patients undergoing CRS + HIPEC were 86.9%, 70.5%, 63.7% and 55.7% respectively. CRS + HIPEC for the treatment rather than prophylaxis of PM was the only predictor of a reduced 3y SR. CONCLUSIONS: CRS + HIPEC may lead to improved prognosis for patients suffering from locally advanced gastric cancer in both prophylactic and curative settings. However, due to far from negligible postoperative morbidity and mortality rates, a strict patient selection is crucial to achieve the best results. The presence of extraperitoneal disease strongly limits the indication of this kind of surgery.
Authors: Michel Adamina; Maxime Warlaumont; Martin D Berger; Silvio Däster; Raphaël Delaloye; Antonia Digklia; Beat Gloor; Ralph Fritsch; Dieter Koeberle; Thibaud Koessler; Kuno Lehmann; Phaedra Müller; Ralph Peterli; Frédéric Ris; Thomas Steffen; Christian Stefan Weisshaupt; Martin Hübner Journal: Cancers (Basel) Date: 2022-09-01 Impact factor: 6.575
Authors: Marek Mazurek; Małgorzata Szlendak; Alicja Forma; Jacek Baj; Ryszard Maciejewski; Giandomenico Roviello; Luigi Marano; Franco Roviello; Karol Polom; Robert Sitarz Journal: Int J Environ Res Public Health Date: 2022-01-07 Impact factor: 3.390