42. Efficacy and safety of intraperitoneal chemotherapy (IPC) for patients with gastric cancer: A meta-analysis

Purpose: The objective of this paper was to evaluate the role and safety of intraperitoneal chemotherapy (IPC) for patients with gastric cancer.
Methods: RCTs on IPC in gastric cancer were searched for in Medline, Embase, Pubmed, and the Cochrane Library and so on. After the trials were selected based on the screening criteria, Jadad scoring table was used to assess their methodological qualities. Data were extracted and Revman 5.16 software was used to perform a meta-analysis.
Results: The meta-analysis consisted of 13 studies, including 9 high-quality papers, 4 low-quality papers, and a total of 1,466 patients. The results of the meta-analysis demonstrated that hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) and hyperthermic intraoperative intraperitoneal chemotherapy combined with postoperative intraperitoneal chemotherapy (HIIC combined with PIC) could significantly lower the mortality rate (HIIC group: OR=0.54, 95% CI=0.39 to 0.75, P=0.0002; HIIC combined with PIC group OR=0.35, 95% CI=0.19 to 0.65, P=0.0009). Normothermic intraoperative intraperitoneal chemotherapy (NIIC) and normothermic postoperative intraperitoneal chemotherapy (NPIC) also showed mortality reductions, but the results were not as good as HIIC or HIIC combined with PIC. Further analysis showed that IPC remarkably decrease the rate of postoperative hepatic metastasis in gastric cancer patients by 72% (OR=0.28, 95% CI=0.12 to 0.67, P=0.004) and played a weak role in preventing postoperative peritoneal relapse (OR=0.61, 95% CI=0.39 to 0.96, P=0.03). Intraperitoneal chemotherapy was also found to be associated with high risks of marrow depression (OR=3.81, 95% CI=1.67 to 8.70, P=0.002), fever (OR=3.66, 95% CI=1.34 to 9.94, P=0.01) and intra-abdominal abscess (OR=3.57, 95% CI =1.49 to 8.57, P=0.004).
Conclusions: The present meta-analysis indicates that IPC can increase the postoperative long-term survival rate of gastric cancer patients and can significantly reduce the rate of hepatic metastasis; adding the thermal effect could further benefit the patients. However, IPC is associated with increased risks of marrow depression, fever and intra-abdominal abscess.