SURGICAL OUTCOMES AND PROGNOSTIC FACTORS AFTER CONVERSION GASTRECTOMY FOR GASTRIC CANCER PERITONEAL METASTASES
Daryl K. Chia*, Raghav Sundhar, Guo Wei Kim, Jia Jun Ang, Asim Shabbir, Wei Peng Yong, Jimmy B. So
Department of Surgery, National University Health System (NUHS), Singapore, Singapore
Introduction
Conversion gastrectomy is increasingly being considered for gastric cancer peritoneal metastases (GCPM) patients who have good response to intraperitoneal paclitaxel (IP-PTX) with systemic therapy. However, the outcomes of surgery are unclear. Our study aimed to evaluate surgical outcomes and prognostic factors for conversion surgery.
Methods
Patients with GCPM were recruited for a prospective phase II trial and received IP-PTX with oral capecitabine and intravenous oxaliplatin (XELOX) in 21-day cycles. Those with good response to chemotherapy, had negative peritoneal fluid cytology with no extraperitoneal metastases and no carcinomatosis peritonei on re-look diagnostic laparoscopy underwent conversion gastrectomy. Primary outcome was overall survival (OS) and secondary endpoint were morbidity and especially those with Clavien-Dindo IIIb & Above.
Results
Of 64 patients with synchronous GCPM, 20 (31.3%) underwent conversion gastrectomy. Median operative time was 316 minutes (IQR 279-368) and median length of stay was 9 days (IQR 7-15). Distal gastrectomy was performed in 45% (9/20) while 55% (11/20) underwent total gastrectomy, with 85% (17/20) performed as open procedure. No combined organ resection or 30-day mortality was noted. Median lymph node harvest was 37 (IQR 23-44) and R0 resection margin was achieved in 65% (13/20) of patients but did not significantly influence median OS (R0 vs. R1-2, median OS; 29.5 vs. 20.7 months, p=0.442). Overall morbidity was 35% (7/20) & major morbidity reported in 10% (2/20) of patients who underwent re-operation for duodenal stump leak and bleeding. The overall 12-month OS was 85% and 24-months OS was 50%. Patients with poorer response to pre-operative therapy (tumour response grading [TRG] <3, p=0.082) and presence of LVI (p=0.057) were found to be associated with OS <24 months although significance was not reached. On survival analysis, median OS for patients with good response to pre-operative treatment (TRG <3) and those who did not (TRG=3) were 28.1 months and 16.0 months respectively (TRG<3, HR 0.085, 95% CI 0.016-0.44).
Conclusions
Conversion gastrectomy is a safe and feasible option for select GCPM patients following IP-PTX with systemic treatment. Response to pre-operative treatment was a significant predictor in overall survival after conversion surgery.
Back to 2023 Abstracts