Cytoreductive surgery combined with hyperthermic intraperitoneal chemoperfusion for the treatment of gastric cancer: A single-centre retrospective study

Figures & data

Table 1. Patient demographics and descriptive data.

Characteristic	N = 231 cases
Median age in years (range)	55.1 (18–78)
Sex
Male	162
Female	69
TNM stage
I^a	18
II	10
III	122
IV	81
Ascites
Positive	48
Negative	142
Unknown	41
Sites of invasion	61
Peritoneum	23
Ovary	6
Colon (%)	6
Pancreas	7
Gullet	11
Liver	8
Histological diagnosis
Well differentiated adenocarcinoma	37
Moderately differentiated adenocarcinoma	28
Poorly/undifferentiated adenocarcinoma	157
Signet ring cell carcinoma	10
Mucous carcinoma	8
Others^b	11
Post-operative chemotherapy
Yes	80
No	151

a T1N1.

b Mesenchymoma, lymphoma, plasma cell granuloma and unknown.

TNM, tumour, node, metastasis stage.

Table 2. Procedure characteristics.

Characteristic	N = 231 cases
Blood loss, median mL (range)	242.1 (5–3500)
Overall hospital stay, median days (range)	19.1 (5–90 days)
Cytoreductive surgery procedure
Gastrectomy	222 (96.0%)
Colectomy	5 (2.2%)
Pancreatectomy	2 (0.9%)
Splenectomy	2 (0.9%)
Completeness of cytoreduction
0	131 (56.7%)
1	60 (26.0%)
2	5 (2.2%)
3	25 (10.8%)
Unknown	10 (4.3%)

Table 3. Tumour marker measurement before and after treatment.

	CCR-0		CCR-1		CCR ≥2
Tumour markers	Before	After	Before	After	Before	After
CEA (ng/mL)	16.73 ± 3.15	6.19 ± 4.21	14.68 ± 5.91	5.21 ± 3.71	19.78 ± 14.12	13.67 ± 12.19
CA199 (U/mL)	97.26 ± 21.38	22.58 ± 16.73	138.91 ± 40.19	36.59 ± 27.88	552.87 ± 321.92	492.16 ± 302.18
CA125 (U/mL)	32.17 ± 6.36	12.49 ± 8.73	42.26 ± 23.29	39.41 ± 42.50	52.18 ± 50.33	49.46 ± 44.33

CEA: carcinoembryonic antigen; CA199: carbohydrate antigen 199; CA125: carbohydrate antigen 125; CCR: completeness of cytoreduction.

Figure 1. Kaplan–Meier survival curves after treatment with CRS combined with HIPEC. (A) Overall survival of gastric cancer patients subjected to HIPEC. (B) Overall survival of gastric cancer patients subjected to curative and palliative procedures. (C) Overall survival of gastric cancer patients with or without ascites. (D) Overall survival of gastric cancer patients with stages III and IV (P < 0.01, Stage IV vs. Stage III). (E) Overall survival of gastric cancer patients with CCR-0, 1 and -3 (P = 0.002, CCR-0 vs. CCR >0).

Table 4. Summary of multivariate analysis of overall survival duration in all patients.

		95% CI
Parameters	HR	Lower	Upper	P
TNM stage (III vs. IV)	0.393	0.172	0.897	0.027
Surgery (curative vs. palliative)	1.369	0.627	2.991	0.431
Ascites (positive vs. negative)	0.394	0.213	0.727	0.003
Repeats of HIPEC (2 vs. 3)	1.054	0.595	1.865	0.857
CCR (0 vs. >0)	0.425	0.187	0.769	0.013
Post-operative chemotherapy (yes vs. no)	268.579	0	0.001	0.929
Gender (male vs. female)	1.219	0.681	2.181	0.506
Age (>55 vs. <55)	0.703	0.389	1.273	0.245
Hospital stay (>19 days vs. <19 days)	0.865	0.495	1.513	0.612

CCR: completeness of cytoreduction; HIPEC: hyperthermic intraperitoneal chemoperfusion; Hazard rate (HR), TNM: tumour, node, metastasis.

Table 5. Complication profiles of patients subjected to cytoreductive surgery combined with HIPEC treatment.

Event	N
Hypoproteinaemia
Grade I	4
Grade II	4
Grade III	1
Grade IV	0
Total	9(3.9%)
Electrolyte disturbance
Grade I	1
Grade II	0
Grade III	1
Grade IV	0
Total	2(0.9%)
Vomiting
Grade I	3
Grade II	1
Grade III	0
Grade IV	0
Total	4(1.7%)
Ileus
Grade I	0
Grade II	1
Grade III	0
Grade IV	0
Total	1(0.4%)
Multiple organ failure
Grade I	0
Grade II	0
Grade III	0
Grade IV	2
Total	2 (0.9%)