Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2023; 29(18): 2850-2863
Published online May 14, 2023. doi: 10.3748/wjg.v29.i18.2850
Prolonged hyperthermic intraperitoneal chemotherapy duration with 90 minutes cisplatin might increase overall survival in gastric cancer patients with peritoneal metastases
Heinrich Steinhoff, Miklos Acs, Sebastian Blaj, Magdolna Dank, Magdolna Herold, Zoltan Herold, Jonas Herzberg, Patricia Sanchez-Velazquez, Tim Strate, Attila Marcell Szasz, Pompiliu Piso
Heinrich Steinhoff, Miklos Acs, Sebastian Blaj, Pompiliu Piso, Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg 93049, Germany
Magdolna Dank, Zoltan Herold, Attila Marcell Szasz, Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest 1083, Hungary
Magdolna Herold, Department of Internal Medicine and Hematology, Semmelweis University, Budapest 1088, Hungary
Jonas Herzberg, Tim Strate, Department of Surgery, Krankenhaus Reinbek St. Adolf-Stift, Reinbek 21465, Germany
Patricia Sanchez-Velazquez, Department of General Surgery, Hospital del Mar, Barcelona 08003, Spain
Author contributions: Steinhoff H, Acs M, Szasz AM and Piso P built the study design; Steinhoff H, Acs M, Blaj S and Sanchez-Velazquez P were involved in the collection of patient data; Herold Z performed the statistical analysis of data; Steinhoff H, Acs M, Herold Z, Herold M, Herzberg J, Strate T and Szasz AM interpreted the data; Steinhoff H, Blaj S, Acs M, Sanchez-Velazquez P and Piso P were involved in patient selection; Steinhoff H, Acs M and Herold Z prepared the draft of the manuscript; All authors were involved in the manuscript editing and reviewing; Dank M and Piso P supervised the study; all authors have read and agreed to the published version of the manuscript.
Institutional review board statement: The study was conducted according to the guidelines of the Declaration of Helsinki. Ethical review and approval were waived for this study due to the retrospective nature of the study. All the patients had agreed to data recording for the national HIPEC registry and to the use of their anonymized data for quality assurance and research purposes by written and verbal informed consent prior to surgery. Therefore, no institutional or further approval of a review board was necessary.
Informed consent statement: Informed consent was obtained from all subjects before cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). All patients agreed to their data being recorded for the national HIPEC registry, administered by the German Society for General and Visceral Surgery.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Heinrich Steinhoff, MD, Doctor, Surgeon, Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Prüfeninger Str. 86, Regensburg 93049, Germany.
Received: November 18, 2022
Peer-review started: November 18, 2022
First decision: February 15, 2023
Revised: February 27, 2023
Accepted: April 10, 2023
Article in press: April 10, 2023
Published online: May 14, 2023

Advanced gastric cancer with synchronous peritoneal metastases (GC-PM) is associated with a poor prognosis. Although cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a promising approach, only a limited number of Western studies exist.


To investigate the clinicopathological outcomes of patients who underwent CRS-HIPEC for GC-PM.


A retrospective analysis of patients with GC-PM was conducted. All patients were seen at the Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany between January 2011 and July 2021 and underwent CRS-HIPEC. Preoperative laboratory results, the use of neoadjuvant trastuzumab, and the details of CRS-HIPEC, including peritoneal carcinomatosis index, completeness of cytoreduction, and surgical procedures were recorded. Disease-specific (DSS), and overall survival (OS) of patients were calculated.


A total of 73 patients were included in the study. Patients treated with neoadjuvant trastuzumab (n = 5) showed longer DSS (P = 0.0482). Higher white blood cell counts (DSS: P = 0.0433) and carcinoembryonic antigen levels (OS and DSS: P < 0.01), and lower hemoglobin (OS and DSS: P < 0.05) and serum total protein (OS: P = 0.0368) levels were associated with shorter survival. Longer HIPEC duration was associated with more advantageous median survival times [60-min (n = 59): 12.86 mo; 90-min (n = 14): 27.30 mo], but without statistical difference. To obtain additional data from this observation, further separation of the study population was performed. First, propensity score-matched patient pairs (n = 14 in each group) were created. Statistically different DSS was found between patient pairs (hazard ratio = 0.2843; 95% confidence interval: 0.1119-0.7222; P = 0.0082). Second, those patients who were treated with trastuzumab and/or had human epidermal growth factor receptor 2 positivity (median survival: 12.68 mo vs 24.02 mo), or had to undergo the procedure before 2016 (median survival: 12.68 mo vs 27.30 mo; P = 0.0493) were removed from the original study population.


Based on our experience, CRS-HIPEC is a safe and secure method to improve the survival of advanced GC-PM patients. Prolonged HIPEC duration may serve as a good therapy for these patients.

Keywords: Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy, Peritoneal metastasis, Stomach neoplasms, Gastric cancer

Core Tip: Advanced gastric cancer (GC) cases with peritoneal metastases are known for their poor survival rates. It has been previously reported that these patients benefit from cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) but available data on this treatment are scarce. In this study, we retrospectively analyzed the clinicopathological and laboratory data of 73 patients with advanced GC and synchronous peritoneal metastases. It was found that prolonged HIPEC duration after macroscopic complete CRS in the scope of multimodal treatment along with advanced perioperative chemotherapy and biologicals may serve as the best currently available therapy for these patients.