(PM P13) Laparoscopic HIPEC for Low-volume Peritoneal Metastasis in Gastric and Gastroesophageal Adenocarcinoma

Background We sought to determine whether laparoscopic hyperthermic intraperitoneal chemotherapy (LS-HIPEC) is associated with improved overall survival (OS) in patients with gastric and gastroesophageal adenocarcinoma metastatic to the peritoneum. Methods We reviewed data from a prospectively maintained database of patients with gastric and gastroesophageal adenocarcinoma to identify patients with radiologically occult carcinomatosis or positive peritoneal cytology, without evidence of distant metastasis and without disease progression during initial chemotherapy or observation. Univariate and multivariable analyses were performed to evaluate the impact of LS-HIPEC on OS. Results We identified 25 patients who underwent LS-HIPEC and 27 patients in a comparison group who did not, due to patient (33%) or provider (48%) preference, financial limitations (15%), or therapy complication (4%). The LS-HIPEC group was younger with a mean age of 57 years compared with 64 years (p=0.016). Rates of carcinomatosis were similar between the groups. Resection was ultimately performed in 28% of LS-HIPEC patients and no patients in the comparison group. Median follow-up was 55 (range: 20-81) months. Kaplan-Meier analysis (Figure¬) demonstrated no statistically significant difference in OS (p=0.14). Median OS was 26.1 (range: 7.5-59.2) months with LS-HIPEC compared with 21.7 (range: 6.9-73.8) months in the comparison group. Three-year OS in the LS-HIPEC group was 25.4%, compared with 8.5% (p=0.14). Conclusion Laparoscopic HIPEC, as part of a multidisciplinary program focused on treating peritoneal disease, appears promising but is not associated with a significant improvement in OS. Multi-institutional and cooperative group trials are needed to assess the benefit of LS-HIPEC in patients with low-volume peritoneal disease. (Figure included via email.)