Gastric Cancer

, Volume 22, Issue 6, pp 1226–1237 | Cite as

The efficacy of treatment options for patients with gastric cancer and peritoneal metastasis

  • Beate RauEmail author
  • Andreas Brandl
  • Peter Thuss-Patience
  • Fabian Bergner
  • Wieland Raue
  • Alexander Arnold
  • David Horst
  • Johann Pratschke
  • Matthias Biebl
Original Article



Patients with peritoneal metastases of gastric cancer have a poor prognosis and median survival of 7 months. This study compared treatment options and outcomes based on the Peritoneal Cancer Index (PCI).


This retrospective analysis included patients with gastric cancer treated between August 2008 and December 2017 with synchronous peritoneal metastases only diagnosed by laparoscopy. The three treatments were as follows: (1) cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in combination with pre- and postoperative systemic chemotherapy (n = 58), (2) laparotomy/laparoscopy without CRS, but HIPEC in combination with pre- and postoperative systemic chemotherapy (n = 11), and (3) systemic chemotherapy only (n = 19).


A total of 88 patients aged 54.6 ± 10.9 years with mean PCI of 14.3 ± 11.3 were included. The PCI was significantly lower in group 1 (8.3 ± 5.7) than in group 2 (23.9 ± 11.1, p < 0.001) and group 3 (27.3 ± 9.3, p < 0.001). Mean time from diagnosis to laparoscopy was 5.2 ± 2.9 months. The median overall survival was 9.8 ± 0.7 for group 1, 6.3 ± 3.0 for group 2 and 4.9 ± 1.9 months for group 3 (p < 0.001). Predictors for deteriorated overall patient survival included > 4 cycles of preoperative chemotherapy (HR 4.49, p < 0.001), lymph-node metastasis (HR 3.53, p = 0.005), PCI ≥ 12 (HR 2.11, p = 0.036), and incompleteness of cytoreduction (HR 4.30, p = 0.001) in patients treated with CRS and HIPEC.


CRS and HIPEC showed convincing results in selected patients with PCI < 12 and complete cytoreduction. Prolonged duration (> 4 cycles) of preoperative intravenous chemotherapy reduced patient survival in patients suitable for CRS and HIPEC.


Peritoneal metastases Gastric cancer Hyperthermic intraperitoneal chemotherapy Cytoreductive surgery Preoperative chemotherapy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent or substitute for it was obtained from all patients included in the study.


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019

Authors and Affiliations

  1. 1.Department of Surgery, Campus Virchow-Klinikum and Charité Campus MitteCharité-Universitätsmedizin BerlinBerlinGermany
  2. 2.Medical Clinic for Hematology, Oncology and Tumor-Immunology, Campus Virchow-KlinikumCharité-Universitätsmedizin BerlinBerlinGermany
  3. 3.Department of General, Visceral and Thoracic SurgeryAKH CelleCelleGermany
  4. 4.Institute of PathologyCharité-Universitätsmedizin BerlinBerlinGermany

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