Pressurized intraperitoneal aerosol chemotherapy in combination with cytoreductive surgery in patients with gastric cancer and limited peritoneal carcinomatosis

Cytoreductive surgery in combination with preoperative chemotherapy (also known as conversion surgery) is a promising treatment option for patients with limited peritoneal carcinomatosis. Local chemotherapy combined with cytoreductive procedures is widely discussed in literature as preventive approach for intraoperative dissemination. Objective. To This study aimed to evaluate the safety and efficacy of Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in combination with cytoreductive surgery for patients with gastric cancer and limited peritoneal carcinomatosis (PCI < 7). Material and methods. Between 2019 and 2023, in total 20 patients with gastric cancer and limited peritoneal carcinomatosis underwent cytoreductive surgeries combined with PIPAC session at the NMIC of Radiology, Ministry of Health, Russian Federation. Results. Of the 21 patients, 3 (31.1%) had a partial response, in 17 patients primary tumor stabilization was observed after preoperative treatment, in 10 patients (50%), a complete response of peritoneal metastasis was achieved. All patients underwent complete cytoreduction (R0/CC-0). Major pathological response of the primary tumor was achived in 2 (10%) patients — TRG1a per Becker and in 4 (20%) — TRG1b per Becker, TRG2 and TRG3 in 5 (25%) and 9 (45%) patients, respectively. The median overall survival was 27 months and the disease-free survival was 7 months. 1-year and 2-year overall survival rates were 95% and 60%, respectively. Conclusion. Cytoreductive surgery in combination with PIPAC is feasible and safe. The survival rates demonstrate the potential ef-fectiveness of this method. However, in order to make a clear assessment of the efficacy of adjuvant intraperitoneal chemotherapy as an approach for preventing intraoperative dissemination during cytoreductions, further randomized controlled trials is needed. © 2024, Media Sphera Publishing Group. All rights reserved.