Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2020; 12(5): 569-581
Published online May 15, 2020. doi: 10.4251/wjgo.v12.i5.569
Gastric cancer with peritoneal metastases: Efficiency of standard treatment methods
Roman Yarema, Мyron Оhorchak, Petro Hyrya, Yuriy Kovalchuk, Victor Safiyan, Ivan Karelin, Severyn Ferneza, Markiyan Fetsych, Myron Matusyak, Yuriy Oliynyk, Тaras Fetsych
Roman Yarema, Severyn Ferneza, Markiyan Fetsych, Yuriy Oliynyk, Тaras Fetsych, Department of oncology and Radiology, Danylo Halytsky Lviv National Medical University, Lviv 79010, Ukraine
Мyron Оhorchak, Petro Hyrya, Yuriy Kovalchuk, Victor Safiyan, Ivan Karelin, Myron Matusyak, Department of Abdominal Surgery, Lviv Oncological Regional Treatment and Diagnostic Center, Lviv 79000, Ukraine
Author contributions: Yarema R designed and performed the research and wrote the paper; Оhorchak M designed the research and supervised the report; Ferneza S, Fetsych M, Oliynyk Y contributed to the analysis; Hyrya P, Kovalchuk Y, Safiyan V, Karelin I and Matusyak M provided clinical advice; Fetsych T supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Lviv Oncological Regional Treatment and Diagnostic Center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
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: Roman Yarema, MD, PhD, Surgical Oncologist, Department of Oncology and Radiology, Danylo Halytsky Lviv National Medical University, 69 Pekarska Street, Lviv 79010, Ukraine.
Received: December 29, 2019
Peer-review started: December 29, 2019
First decision: February 20, 2020
Revised: March 24, 2020
Accepted: March 28, 2020
Article in press: March 28, 2020
Published online: May 15, 2020
Research background

Peritoneal metastasis is the most common pattern of synchronous and metachronous dissemination of gastric cancer (GC). Such patients are characterized by poor prognoses. New therapeutic modalities are being increasingly employed. However, the results of existing standard treatment methods remain insufficiently reported in the literature.

Research motivation

A large number of reports of results from modern methods of combined treatment of GC patients with peritoneal metastases (hyperthermic intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy, pressurized intraperitoneal aerosol chemotherapy, etc) are now available in the literature. Most of them relate to early stages of peritoneal carcinomatosis (according to classifications of the Japanese Gastric Cancer Association and peritoneal cancer index). However, medical publications on standard treatment topics are focused on a broad category of patients with intraperitoneally-disseminated GC or with metastases of different forms.

Research objectives

To develop more advanced methods, it becomes necessary to study the results of existing standard treatment methods (i.e., palliative chemotherapy, palliative gastrectomy, and best supportive care) in patients with intraperitoneally-disseminated GC in order to perform a comparative analysis of strategies.

Research methods

A retrospective analysis of the efficiency of standard treatment methods was performed on 200 GC patients with synchronous peritoneal metastases.

Research results

The median overall survival and 1-year survival of patients with РCI of 1-6, 7-12, and 13+ points were 8.5 mo, 4.2 mo, and 4.1 mo, and 39.8%, 6.7%, and 5.5%, respectively. Long-term survivors were found in the group with PCI of 1-6 points and there was no survival difference in groups with PCI 7-12 vs PCI 13+ points. Palliative gastrectomy increased the median overall survival to 12.6 mo compared to conservative approach of 8.0 mo in patients with РCI of 1-6 points. In patients with РCI 13+ points, only palliative chemotherapy increased the overall survival to 6.0 mo compared to 3.4 mo for best supportive care.

Research conclusions

GC patients with peritoneal metastases are characterized by extremely poor prognoses. Palliative gastrectomy could prove effective in treating patients with early stage peritoneal metastases. The three standard treatment methods are equally effective for moderate stages of peritoneal metastases. In cases with far advanced peritoneal carcinomatosis, a significant increase in prognosis was registered only after treatment with palliative chemotherapy.

Research perspectives

Generated objective data of the study could be used for comparative analysis in subsequent studies of new combined treatments.