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Annals of Surgical Oncology

, Volume 14, Issue 10, pp 2702–2713 | Cite as

A Systematic Review and Meta-analysis of the Randomized Controlled Trials on Adjuvant Intraperitoneal Chemotherapy for Resectable Gastric Cancer

  • Tristan D. Yan
  • Deborah Black
  • Paul H. Sugarbaker
  • Jacqui Zhu
  • Yutaka Yonemura
  • George Petrou
  • David L. Morris
Gastrointestinal Oncology

Abstract

Background

The purpose of this systematic review and meta-analysis was to determine the effectiveness and safety of adjuvant intraperitoneal chemotherapy for patients with locally advanced resectable gastric cancer.

Methods

Studies eligible for this systematic review included those in which patients with gastric cancer were randomly assigned to receive surgery combined with intraperitoneal chemotherapy versus surgery without intraperitoneal chemotherapy. There were no language restrictions. After independent quality assessment and data extraction, data were pooled for meta-analysis.

Results

Thirteen reports of randomized controlled trials (RCTs) were included for quality appraisal and data extraction. Ten reports were judged to be of fair quality and subjected to meta-analysis. A significant improvement in survival was associated with hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) alone (hazard ratio [HR] = 0.60; 95% CI = 0.43 to 0.83; p = 0.002) or HIIC combined with early postoperative intraperitoneal chemotherapy (EPIC) (HR = 0.45; 95% CI = 0.29 to 0.68; p = 0.0002). There was a trend towards survival improvement with normothermic intraoperative intraperitoneal chemotherapy (p = 0.06), but this was not significant with either EPIC alone or delayed postoperative intraperitoneal chemotherapy. Intraperitoneal chemotherapy was also found to be associated with higher risks of intra-abdominal abscess (RR = 2.37; 95% CI = 1.32 to 4.26; p = 0.003) and neutropenia (RR = 4.33; 95% CI = 1.49 to 12.61; p = 0.007).

Conclusions

The present meta-analysis indicates that HIIC with or without EPIC after resection of advanced gastric primary cancer is associated with improved overall survival. However, increased risk of intra-abdominal abscess and neutropenia are also demonstrated.

Keywords

Gastric carcinoma Intraperitoneal chemotherapy 

Notes

Acknowledgments

All authors declare that there are no potential conflicts of interest. Tristan D. Yan, a surgical oncology research fellow, is partly sponsored by the Foundation for Applied Research in Gastrointestinal Oncology. The authors gratefully acknowledge Drs/Profs M. Ikeguchi, W. Yu, H. Rosen, L. Xin, Y. Yonemura, G. Wei and Z. Gao for providing advice or additional unpublished information regarding their respective trials. We thank Profs L. Xin and Y. Yonemura for translating studies published in Chinese and Japanese languages.

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Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Tristan D. Yan
    • 1
    • 2
  • Deborah Black
    • 3
  • Paul H. Sugarbaker
    • 2
  • Jacqui Zhu
    • 4
  • Yutaka Yonemura
    • 5
  • George Petrou
    • 1
  • David L. Morris
    • 1
  1. 1.Department of SurgeryUniversity of New South Wales, St George HospitalSydneyAustralia
  2. 2.Department of Surgical OncologyWashington Cancer Institute, Washington Hospital CenterWashingtonUSA
  3. 3.School of Public Health and Community MedicineUniversity of New South WalesSydneyAustralia
  4. 4.School of MedicineUniversity of New South WalesSydneyAustralia
  5. 5.Department of Gastric CancerShizuoka Cancer CenterShizuokaJapan

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