Risk Factors for Recurrence after Complete Cytoreductive Surgery and Perioperative Chemotherapy in Peritoneal Metastases from Gastric Cancer

Background and objective: The aim of this study is to analyze anatomical distribution, timing and outcomes of recurrence after complete cytoreduction and perioperative chemotherapy for peritoneal metastasis from gastric cancer (GCPM). Method: Data of 193 GCPM patients who underwent a complete cytoreductive surgery (CRS) after treatment with neoadjuvant chemotherapy were entered into a prospective database and the recurrence was analyzed. Result: The median time to progression was 16.2 months, median overall survival (OS) was 21.6 months and 5-year survival rate was 18.1%. Five years after CRS, 11 patients were disease free survivors. Recurrence rate was 68.5% (126/184). Mutivariate analysis confirmed small bowel peritoneal cancer index of ≥3 and pathologic nonresponders after NAC as independent risk factors for recurrence. Patients were treated with systemic chemotherapy or second cytoreductive surgery for recurrence. However, survival after diagnosis of recurrence was poor with median survival of 2.9 months. The most common type of recurrence was diffuse peritoneal recurrence (71%, 90/126). Localized intra-abdominal recurrence was experienced in only 7 patients. Conclusion: Pathologic non-responders and small bowel PCI of ≥3 are independent risk factors for recurrence. Exploratory laparoscopy after NAC might be a useful strategy for the selection of patients for CRS.