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Prior work has established hyperthermic intraperitoneal chemotherapy (HIPEC) administration as a safe treatment option for select patients with gastric adenocarcinoma and carcinomatosis. However, identifying patients who will maximally benefit from HIPEC remains unclear. This study assessed a single-institution experience with HIPEC for metastatic gastric cancer to identify variables associated with improved survival. A database of patients treated for metastatic gastric adenocarcinoma at MD Anderson Cancer Center from 2013 to 2022 was queried for patients undergoing HIPEC as part of their treatment regimen. Patients were stratified by overall survival (OS)≥36 months or <36 months and assessed along demographic and clinicopathologic variables to identify factors associated with OS ≥ 36 months. Among 104 patients, 1,2, and 3-year OS from diagnosis was 89 %,44 %, and 18 %. Patients with OS ≥ 36 months were more likely to have moderately differentiated tumors, positive cytology only (i.e. no visible carcinomatosis), and lower peritoneal cancer index (PCI) than those with OS < 36 months (p = 0.002, p = 0.01, p = 0.001,respectively). Groups did not otherwise differ with respect to demographic parameters or treatment or pathologic details. Among patients who underwent gastrectomy, those with OS < 36 months had higher pathologic T and N category (p = 0.003 and p = 0.02, respectively). Postoperative mortality was zero in both groups among patients undergoing gastrectomy. HIPEC may provide more durable survival benefit among patients with metastatic gastric cancer with moderately differentiated disease, low PCI, and positive cytology alone. Additionally, among patients who undergo gastrectomy, higher final pathologic T and N category are associated with worse survival. Trials are needed to compare 3-year OS rates in patients treated with HIPEC versus systemic therapy alone. [ABSTRACT FROM AUTHOR]

Background Esophageal perforation is an injury associated with high morbidity and mortality. Initial management ranges from observation to esophagectomy. The aim of this study was to evaluate the relative mortality and safety of emergent esophagectomy for acute esophageal rupture when compared with elective esophagectomies. Methods We performed a retrospective review of a prospective esophagectomy database from a single institution from 1977 to 2013. Patients who were admitted for esophageal perforation and underwent esophagectomy were identified and compared with patients who underwent elective esophagectomy. Results In all, 3,015 patients received an esophagectomy in elective and emergent settings; 90 esophagectomies were for acute injuries (52 for benign and 38 for malignant causes). A longer median length of stay was associated with emergent esophagectomy compared with elective esophagectomy (13 versus 10 days, p < 0.0001), and the complication rates were higher in the emergent group (51.1% versus 35.6%, p = 0.003). The survival rates at 30 days, 1 year, and 5 years after surgery were not significantly different between the emergent and nonemergent esophagectomy groups for patients with both benign and malignant underlying conditions. Within the emergent group, there was no difference in 30-day or 6-month survival based on benign or malignant causes, but a significant difference was seen at 1 year (85% for benign versus 65% for malignant, p = 0.025) and 5 years for survival (72% versus 21%, p < 0.001). Conclusions Emergent esophagectomy represents a safe option for the treatment of esophageal perforation, with mortality comparable to elective esophagectomy. [ABSTRACT FROM AUTHOR]