Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) versus palliative chemotherapy for peritoneal metastasized gastric cancer: a propensity score matched analysis
In brief
For limited stomach cancer spread, surgery plus heated chemotherapy nearly doubled median survival
In this retrospective international cohort, patients with limited peritoneal spread who had surgery plus heated chemotherapy after induction treatment lived a median 23.5 months, compared with 11.8 months with chemotherapy alone, after propensity matching. The association was similar across disease-burden subgroups, but the nonrandomized design cannot show that surgery caused the survival difference.
- Journal
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Q1)
- Published
- 25 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Lianne Triemstra, Halit Topal, Annouschka Laenen, Emma C Gertsen, Hylke J F Brenkman, Nadia Haj Mohammad, et al.
- PMID
- 42822220
- DOI
- 10.1016/j.ejso.2026.112175
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 4 October 2026): CRS+HIPEC vs chemo for gastric PM, relevant trial
Abstract
INTRODUCTION: The role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer patients with peritoneal metastases (PM) and a low peritoneal cancer index (PCI) remains debated. We compared real-world overall survival (OS) between induction chemotherapy followed by CRS with HIPEC versus palliative chemotherapy-only in gastric cancer patients with peritoneal metastases (PM). METHODS: This retrospective, international multicenter cohort study analyzed gastric cancer patients with synchronous PM (cT1-4N0-3M1) treated with induction chemotherapy and CRS + HIPEC (UZ Ghent/UZ Leuven) versus palliative chemotherapy-only (nationwide Netherlands Cancer Registry). The primary outcome was OS for PCI≤12. Secondary outcomes were OS for patient subgroups with PCI≤6, and PCI 7-12. Covariate adjustment and 1:1 propensity-score-matching (PSM) addressed baseline differences. Survival was analyzed using the Kaplan-Meier method and Cox proportional hazards models with hazard ratios (HR). RESULTS: Between 2009 and 2022, 233 patients with PCI≤12 were included. Patients treated with CRS + HIPEC (n = 52) had a significantly higher OS after covariate adjustment (HR 0.40; 95% CI 0.26-0.63, p < 0.001) versus patients treated with chemotherapy-only (n = 181). After 1:1-PSM, for PCI≤12 (n = 82), median OS was 23.5 months (CRS + HIPEC) versus 11.8 (chemotherapy-only) (HR 0.30; 95% CI 0.17-0.54, p < 0.001). After 1:1 PSM for patient subgroups with PCI≤6 (n = 58) and PCI 7-12 (n = 20), median OS was 26.4 and 21.8 months (CRS + HIPEC) versus 13.2 and 12.0 months (chemotherapy-only) (HR 0.27; 95% CI 0.14-0.52, p < 0.001, and HR 0.32; 95% CI 0.11-0.92, p = 0.034). CONCLUSIONS: in this retrospective PSM-cohort CRS + HIPEC was associated with a clinically meaningful higher OS in gastric cancer patients with limited PM compared to chemotherapy-only, supporting its potential.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.