Survival outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in selected patients with stage IV gastric adenocarcinoma – A Canadian case series

Despite advances in systemic therapy, metastatic gastric cancer is associated with a poor prognosis. As peritoneal disease is common, several studies looked at the potential benefits of hyperthermic intraperitoneal chemotherapy (HIPEC) in this context, with encouraging results. However, no Canadian...

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Published in:	European journal of surgical oncology Vol. 51; no. 8; p. 110000
Main Authors:	Bénard, Florence, Marcil, Stéphanie, Mack, Lloyd, Deban, Melina, Bildersheim, Michael, Bouchard-Fortier, Antoine, Osman, Yasmin, Mercier, Frédéric, Purich, Kieran, Haase, Erika, Schiller, Dan, Soucisse, Mikael, Sidéris, Lucas, Leblanc, Guy, Dubé, Pierre, Boulanger-Gobeil, Cindy, Hamilton, Trevor, Gervais, Mai-Kim
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01.08.2025
Subjects:	Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - secondary Adenocarcinoma - therapy Adult Aged Canada Carcinomatosis Cytoreduction Cytoreduction Surgical Procedures Female Gastric cancer HIPEC Humans Hyperthermic Intraperitoneal Chemotherapy Male Metastatic Middle Aged Neoplasm Staging Peritoneal Peritoneal Neoplasms - secondary Peritoneal Neoplasms - therapy Retrospective Studies Stomach Neoplasms - mortality Stomach Neoplasms - pathology Stomach Neoplasms - therapy Survival Rate Canada Peritoneal Carcinomatosis Cytoreduction Metastatic HIPEC Gastric cancer
ISSN:	0748-7983, 1532-2157, 1532-2157
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Abstract	Despite advances in systemic therapy, metastatic gastric cancer is associated with a poor prognosis. As peritoneal disease is common, several studies looked at the potential benefits of hyperthermic intraperitoneal chemotherapy (HIPEC) in this context, with encouraging results. However, no Canadian data currently exists on the subject. This study aims to report characteristics and outcomes of Canadian patients who underwent cytoreductive surgery and HIPEC (CRS-HIPEC) for gastric cancer associated with peritoneal disease or positive peritoneal cytology. This multicenter retrospective study included patients 18 years or older with gastric cancer associated with isolated peritoneal involvement who underwent CRS-HIPEC in five tertiary centers from 2016 to 2022. CRS-HIPEC was performed on 20 patients aged 34–69 years old, most of whom presented with poorly differentiated (90 %) adenocarcinoma, with synchronous peritoneal disease (95 %). Median PCI was 3 (0–13). The associated 90-day morbidity rate, defined as Clavien-Dindo grade III and above complications, was 10 %. At a mean follow-up of 23.3 months (range 4–48), 25 % of patients remained disease-free, with an estimated median overall survival of 24.2 months. CRS-HIPEC for gastric cancer can achieve longer term survival in highly selected patients with low-burden peritoneal disease or positive cytology. Ongoing randomized trials will further clarify patients’ selection criteria and benefits of this approach.
AbstractList	Despite advances in systemic therapy, metastatic gastric cancer is associated with a poor prognosis. As peritoneal disease is common, several studies looked at the potential benefits of hyperthermic intraperitoneal chemotherapy (HIPEC) in this context, with encouraging results. However, no Canadian data currently exists on the subject. This study aims to report characteristics and outcomes of Canadian patients who underwent cytoreductive surgery and HIPEC (CRS-HIPEC) for gastric cancer associated with peritoneal disease or positive peritoneal cytology. This multicenter retrospective study included patients 18 years or older with gastric cancer associated with isolated peritoneal involvement who underwent CRS-HIPEC in five tertiary centers from 2016 to 2022. CRS-HIPEC was performed on 20 patients aged 34–69 years old, most of whom presented with poorly differentiated (90 %) adenocarcinoma, with synchronous peritoneal disease (95 %). Median PCI was 3 (0–13). The associated 90-day morbidity rate, defined as Clavien-Dindo grade III and above complications, was 10 %. At a mean follow-up of 23.3 months (range 4–48), 25 % of patients remained disease-free, with an estimated median overall survival of 24.2 months. CRS-HIPEC for gastric cancer can achieve longer term survival in highly selected patients with low-burden peritoneal disease or positive cytology. Ongoing randomized trials will further clarify patients’ selection criteria and benefits of this approach. Despite advances in systemic therapy, metastatic gastric cancer is associated with a poor prognosis. As peritoneal disease is common, several studies looked at the potential benefits of hyperthermic intraperitoneal chemotherapy (HIPEC) in this context, with encouraging results. However, no Canadian data currently exists on the subject.INTRODUCTIONDespite advances in systemic therapy, metastatic gastric cancer is associated with a poor prognosis. As peritoneal disease is common, several studies looked at the potential benefits of hyperthermic intraperitoneal chemotherapy (HIPEC) in this context, with encouraging results. However, no Canadian data currently exists on the subject.This study aims to report characteristics and outcomes of Canadian patients who underwent cytoreductive surgery and HIPEC (CRS-HIPEC) for gastric cancer associated with peritoneal disease or positive peritoneal cytology. This multicenter retrospective study included patients 18 years or older with gastric cancer associated with isolated peritoneal involvement who underwent CRS-HIPEC in five tertiary centers from 2016 to 2022.MATERIALS AND METHODSThis study aims to report characteristics and outcomes of Canadian patients who underwent cytoreductive surgery and HIPEC (CRS-HIPEC) for gastric cancer associated with peritoneal disease or positive peritoneal cytology. This multicenter retrospective study included patients 18 years or older with gastric cancer associated with isolated peritoneal involvement who underwent CRS-HIPEC in five tertiary centers from 2016 to 2022.CRS-HIPEC was performed on 20 patients aged 34-69 years old, most of whom presented with poorly differentiated (90 %) adenocarcinoma, with synchronous peritoneal disease (95 %). Median PCI was 3 (0-13). The associated 90-day morbidity rate, defined as Clavien-Dindo grade III and above complications, was 10 %. At a mean follow-up of 23.3 months (range 4-48), 25 % of patients remained disease-free, with an estimated median overall survival of 24.2 months.RESULTSCRS-HIPEC was performed on 20 patients aged 34-69 years old, most of whom presented with poorly differentiated (90 %) adenocarcinoma, with synchronous peritoneal disease (95 %). Median PCI was 3 (0-13). The associated 90-day morbidity rate, defined as Clavien-Dindo grade III and above complications, was 10 %. At a mean follow-up of 23.3 months (range 4-48), 25 % of patients remained disease-free, with an estimated median overall survival of 24.2 months.CRS-HIPEC for gastric cancer can achieve longer term survival in highly selected patients with low-burden peritoneal disease or positive cytology. Ongoing randomized trials will further clarify patients' selection criteria and benefits of this approach.CONCLUSIONCRS-HIPEC for gastric cancer can achieve longer term survival in highly selected patients with low-burden peritoneal disease or positive cytology. Ongoing randomized trials will further clarify patients' selection criteria and benefits of this approach.
ArticleNumber	110000
Author	Marcil, Stéphanie Deban, Melina Sidéris, Lucas Bénard, Florence Bildersheim, Michael Mack, Lloyd Bouchard-Fortier, Antoine Osman, Yasmin Gervais, Mai-Kim Haase, Erika Schiller, Dan Hamilton, Trevor Soucisse, Mikael Purich, Kieran Dubé, Pierre Leblanc, Guy Boulanger-Gobeil, Cindy Mercier, Frédéric
Author_xml	– sequence: 1 givenname: Florence orcidid: 0000-0002-8869-2851 surname: Bénard fullname: Bénard, Florence organization: Division of Surgical Oncology, Department of Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), 1051 Rue Sanguinet, Montréal, QC, Canada, H2X 3E4 – sequence: 2 givenname: Stéphanie surname: Marcil fullname: Marcil, Stéphanie organization: Division of Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, 5415 Bd de l'Assomption, Montréal, QC, Canada, H1T 2M4 – sequence: 3 givenname: Lloyd surname: Mack fullname: Mack, Lloyd organization: Division of Surgical Oncology, Department of Surgery, Foothills Medical Center, 1403 29 St NW, Calgary, AB, Canada, T2N 2T9 – sequence: 4 givenname: Melina orcidid: 0000-0002-1768-263X surname: Deban fullname: Deban, Melina organization: Division of Surgical Oncology, Department of Surgery, Foothills Medical Center, 1403 29 St NW, Calgary, AB, Canada, T2N 2T9 – sequence: 5 givenname: Michael surname: Bildersheim fullname: Bildersheim, Michael organization: Division of Surgical Oncology, Department of Surgery, Foothills Medical Center, 1403 29 St NW, Calgary, AB, Canada, T2N 2T9 – sequence: 6 givenname: Antoine surname: Bouchard-Fortier fullname: Bouchard-Fortier, Antoine organization: Division of Surgical Oncology, Department of Surgery, Foothills Medical Center, 1403 29 St NW, Calgary, AB, Canada, T2N 2T9 – sequence: 7 givenname: Yasmin surname: Osman fullname: Osman, Yasmin organization: Division of Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, 5415 Bd de l'Assomption, Montréal, QC, Canada, H1T 2M4 – sequence: 8 givenname: Frédéric surname: Mercier fullname: Mercier, Frédéric organization: Division of Surgical Oncology, Department of Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), 1051 Rue Sanguinet, Montréal, QC, Canada, H2X 3E4 – sequence: 9 givenname: Kieran surname: Purich fullname: Purich, Kieran organization: Division of Surgical Oncology, Department of Surgery, Grey Nuns Community Hospital, 1100 Youville Dr W Northwest, Edmonton, AB, Canada, T6L 5X8 – sequence: 10 givenname: Erika orcidid: 0009-0001-8756-6626 surname: Haase fullname: Haase, Erika organization: Division of Surgical Oncology, Department of Surgery, Grey Nuns Community Hospital, 1100 Youville Dr W Northwest, Edmonton, AB, Canada, T6L 5X8 – sequence: 11 givenname: Dan surname: Schiller fullname: Schiller, Dan organization: Division of Surgical Oncology, Department of Surgery, Grey Nuns Community Hospital, 1100 Youville Dr W Northwest, Edmonton, AB, Canada, T6L 5X8 – sequence: 12 givenname: Mikael orcidid: 0000-0002-4576-5774 surname: Soucisse fullname: Soucisse, Mikael organization: Division of Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, 5415 Bd de l'Assomption, Montréal, QC, Canada, H1T 2M4 – sequence: 13 givenname: Lucas surname: Sidéris fullname: Sidéris, Lucas organization: Division of Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, 5415 Bd de l'Assomption, Montréal, QC, Canada, H1T 2M4 – sequence: 14 givenname: Guy surname: Leblanc fullname: Leblanc, Guy organization: Division of Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, 5415 Bd de l'Assomption, Montréal, QC, Canada, H1T 2M4 – sequence: 15 givenname: Pierre surname: Dubé fullname: Dubé, Pierre organization: Division of Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, 5415 Bd de l'Assomption, Montréal, QC, Canada, H1T 2M4 – sequence: 16 givenname: Cindy surname: Boulanger-Gobeil fullname: Boulanger-Gobeil, Cindy organization: Division of Surgical Oncology, Department of Surgery, Hôtel-Dieu de Québec, 11 Côte du Palais, Québec, Canada, G1R 2J6 – sequence: 17 givenname: Trevor surname: Hamilton fullname: Hamilton, Trevor organization: Division of Surgical Oncology, Department of Surgery, Vancouver General Hospital, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC, Canada, V5Z 1M9 – sequence: 18 givenname: Mai-Kim surname: Gervais fullname: Gervais, Mai-Kim email: mai-kim.gervais.med@ssss.gouv.qc.ca organization: Division of Surgical Oncology, Department of Surgery, Hôpital Maisonneuve-Rosemont, 5415 Bd de l'Assomption, Montréal, QC, Canada, H1T 2M4
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Keywords	Peritoneal Carcinomatosis Cytoreduction Metastatic HIPEC Gastric cancer
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Snippet	Despite advances in systemic therapy, metastatic gastric cancer is associated with a poor prognosis. As peritoneal disease is common, several studies looked at...
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SubjectTerms	Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - secondary Adenocarcinoma - therapy Adult Aged Canada Carcinomatosis Cytoreduction Cytoreduction Surgical Procedures Female Gastric cancer HIPEC Humans Hyperthermic Intraperitoneal Chemotherapy Male Metastatic Middle Aged Neoplasm Staging Peritoneal Peritoneal Neoplasms - secondary Peritoneal Neoplasms - therapy Retrospective Studies Stomach Neoplasms - mortality Stomach Neoplasms - pathology Stomach Neoplasms - therapy Survival Rate
Title	Survival outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in selected patients with stage IV gastric adenocarcinoma – A Canadian case series
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