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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2007

01-10-2007 | Gastrointestinal Oncology

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

Authors: Tristan D. Yan, BSc (Med) MBBS, Deborah Black, BSc DipEd MStat PhD, Paul H. Sugarbaker, MD, Jacqui Zhu, BSc (Med), Yutaka Yonemura, MD, PhD, George Petrou, BSc (Med) MBBS, David L. Morris, MD, PhD

Published in: Annals of Surgical Oncology | Issue 10/2007

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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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Metadata
Title
A Systematic Review and Meta-analysis of the Randomized Controlled Trials on Adjuvant Intraperitoneal Chemotherapy for Resectable Gastric Cancer
Authors
Tristan D. Yan, BSc (Med) MBBS
Deborah Black, BSc DipEd MStat PhD
Paul H. Sugarbaker, MD
Jacqui Zhu, BSc (Med)
Yutaka Yonemura, MD, PhD
George Petrou, BSc (Med) MBBS
David L. Morris, MD, PhD
Publication date
01-10-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 10/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-007-9487-4

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