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
Research background

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is one of the last options in the treatment of advanced gastric cancer (GC) with peritoneal metastasis (PM); however, most national and international guidelines only recommend it to be performed within clinical trials. Despite this, CRS with HIPEC is a safe and effective method to treat advanced GC with PM, and recent studies have shown encouraging results with respect to increased patient survival.

Research motivation

CRS and HIPEC are safe and effective therapeutic options for the treatment of advanced GC with PM. To investigate the optimal length of HIPEC procedure, it is important to provide a basis for further research. Improving the composition of HIPEC medications could further improve the outcomes of this modern multimodal therapy. It is expected that ongoing research regarding antibody and checkpoint inhibitor therapies will strongly influence not only perioperative therapy but also the therapeutic agents used during HIPEC itself.

Research objectives

The aim of the study was to explore the effect of CRS and HIPEC in the treatment of advanced GC with PM and find parameters that could further improve patient survival.

Research methods

We conducted a retrospective observational study with the inclusion of 73 GC patients with synchronous PM. Details of CRS + HIPEC, preoperative laboratory results, and pre-, peri-, and postoperative surgical details of the patients were recorded. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were calculated.

Research results

In line with recently published data, we found that CRS + HIPEC had a measurable impact on the survival of advanced GC patients without significantly elevating the rate of postoperative complications. The effects of longer HIPEC duration, higher white blood cell count, lower hemoglobin and serum total protein, and higher carcinoembryonic antigen levels with respect to the survival of patients were found.

Research conclusions

In general agreement with previously published findings, we concluded that 90 min HIPEC treatment correlates with improvement in the OS and DSS of patients compared to that of 60 min HIPEC. Moreover, more complete cytoreduction also contributes to longer patient survival and better disease management.

Research perspectives

The improvement of CRS and HIPEC with respect to the duration and composition of HIPEC therapeutic agents is a controversial research topic. The current report provides evidence from a single center retrospective study that could be implemented in future randomized multicenter studies.