Comparison Different Methods of Intraoperative and Intraperitoneal Chemotherapy for Patients with Gastric Cancer: A Meta-analysis

Purpose: To investigate the efficacy and safety of intraperitoneal chemotherapy (IPC) for patients withgastric cancer and to compare effects between different regimens of IPC.
Method: Randomized controlledtrials comparing the effects of surgery plus intraperitoneal chemotherapy with surgery alone or comparing theefficacy between different regimens of intraperitoneal chemotherapy were searched for in Medline, Embase,Pubmed, the Cochrane Library and the Chinese BioMedical Disc and so on by two independent reviewers.After quality assessment and data extraction, data were pooled for meta-analysis using RevMan5.16 software.Tests of interaction were used to test for differences of effects among subgroups grouped according to differentIPC regimens.
Results: Fifteen RCTs with a total of 1713 patients with gastric cancer were included for qualityassessment and data extraction. Ten studies were judged to be of fair quality and entered into meta-analysis.Hyperthermic intraoperative intraperitoneal chemotherapy (HR=0.60, P<0.01), hyperthermic intraoperativeintraperitoneal chemotherapy plus postoperative intraperitoneal chemotherapy (HR=0.47, P<0.01) andnormothermic intraoperative intraperitoneal chemotherapy (HR=0.70, P=0.01) were associated with a significantimprovement in overall survival. Tests of interaction showed that hyperthermia and additional postoperativeintraperitoneal chemotherapy did not impact on its effect. Further analysis revealed that intraperitonealchemotherapy remarkably decrease the rate of postoperative hepatic metastasis by 73% (OR=0.27, 95% CI=0.12to 0.67, P<0.01). However, intraperitoneal chemotherapy increased risks of marrow depression (OR=5.74,P<0.01), fever (OR=3.67, P=0.02) and intra-abdominal abscess (OR=3.57, P<0.01).
Conclusion: The presentmeta-analysis demonstrates that hyperthermic intraoperative intraperitoneal chemotherapy and normothermicintraoperative intraperitoneal chemotherapy should be recommended to treat patients with gastric cancerbecause of improvement in overall survival. However, it is noteworthy that intraperitoneal chemotherapy canincrease the risks of marrow depression, intra-abdominal abscesses, and fever.