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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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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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Authors and Affiliations

  1. Department of Surgery, University of New South Wales, St George Hospital, Sydney, NSW, Australia

    Tristan D. Yan BSc (Med) MBBS, George Petrou BSc (Med) MBBS & David L. Morris MD, PhD

  2. Department of Surgical Oncology, Washington Cancer Institute, Washington Hospital Center, Washington, DC, USA

    Tristan D. Yan BSc (Med) MBBS & Paul H. Sugarbaker MD

  3. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia

    Deborah Black BSc DipEd MStat PhD

  4. School of Medicine, University of New South Wales, Sydney, NSW, Australia

    Jacqui Zhu BSc (Med)

  5. Department of Gastric Cancer, Shizuoka Cancer Center, Shizuoka, Japan

    Yutaka Yonemura MD, PhD

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  1. Tristan D. Yan BSc (Med) MBBS
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Correspondence to Tristan D. Yan BSc (Med) MBBS.

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Yan, T.D., Black, D., Sugarbaker, P.H. et al. A Systematic Review and Meta-analysis of the Randomized Controlled Trials on Adjuvant Intraperitoneal Chemotherapy for Resectable Gastric Cancer. Ann Surg Oncol 14, 2702–2713 (2007). https://doi.org/10.1245/s10434-007-9487-4

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