Outcomes for Gastrectomy During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Nongastric Primaries: 30-Year Experience.

Abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can improve survival for patients with peritoneal surface malignancy. Completeness of cytoreduction correlates with prognosis. The role of gastrectomy in these patients is not well described. A total of 1868 patients who underwent CRS+HIPEC for nongastric primary between 1991 and 2024 were analyzed from a prospective database. Patients were stratified by gastrectomy extent and their outcomes compared with no-gastrectomy patients. Continuous variables are presented as mean (SD), categorical variables as N (%), and values considered statistically significant at <0.05. No differences were observed in baseline demographics between the gastrectomy and no-gastrectomy groups. There were 23 major, 45 distal, and 77 wedge gastrectomies (n = 145, 7.76%). Appendiceal was the most common neoplasm in the gastrectomy groups (major: 96%, distal: 91%, wedge: 68%, no gastrectomy: 53%). Gastrectomy patients had higher median peritoneal carcinomatosis index (PCI) (major: 27 [7.0], distal: 24 [7.0], wedge: 19 [10.3], no-gastrectomy: 14 [9.5]; p < 0.001), R2 resection (major: 96%, distal: 89%, wedge: 60%, no-gastrectomy: 45%; p < 0.001), severe complications (major: 30%, distal: 27%, wedge: 19%, no-gastrectomy: 12%; p < 0.001), length of stay (major: 24 [15.2], distal: 23 [25.7], wedge: 18 [22.2], no-gastrectomy: 12 [12.5] days; p < 0.001), and 30-day mortality (major: 17%, distal: 11%, wedge: 10%, no-gastrectomy: 5%; p < 0.001). There was no difference in 30-day readmission or recurrence. On multivariate analysis, gastrectomy was not independently associated with overall survival (p = 0.18). Approximately 8% of patients who underwent CRS+HIPEC for nongastric primaries underwent gastrectomy. Gastrectomy patients were more likely to have higher PCI and incomplete resections with increased complications and mortality. PCI, resection status, lymph nodes, tumor grade, and primary site, but not gastrectomy type, are significantly associated with overall survival.