Prognostic Analysis And Risk Of Postoperative Complications Of Hyperthermic Intraperitoneal Chemotherapy(HIPEC) In Gastric Cancer Patients With Peritoneal Metastases

Objective:To investigate the prognosis of gastric cancer patients with peritoneal metastases(peritoneal cancer index PCI≤7)who received hyperthermic intraperitoneal chemotherapy(HIPEC),and to explore the risk factors affecting the survival rate of patients and the risk of postoperative complications.Methods:This is a single-center retrospective stud y of 124 patients with peritoneal metastases of gastric cancer(PCI≤7)from Shanxi Provincial People’s Hospital(Januar y 2019 to Januar y 2021).All patients underwent cytoreductive surger y(CRS)and postoperative s ystemic chemotherap y(SC)with Oxaliplatin and Tegafur,and did not receive neoadjuvant chemotherap y.Patients were divided into intervention group and control group according to whether they received hyperthermic intraperitoneal chemotherap y(HIPEC)or not.The relationship between gender,age,BM I,tumor size,degree of tumer differentiation,PCI index,reoperative tumor markers and postoperative survival rate of patients was anal yzed.The survival of all patients 1 and 2 years after surger y and the occurrence of postoperative complications were observed.Results:1.The 1-year and 2-year cumulative survival rates of the intervention group were 92.1% and 81.2% respectively.The 1-year cumulative survival rate of the control group was 75%,and the 2-year cumulative survival rate was 63.3%.The Log-rank test was used to compare the survival differences between the two groups.The results showed that the 1-year(P=0.011)and 2-year(P=0.024)overall survival rates in the intervention group were significantly higher than those in the control group,and the difference was statistically significant.2.Cox univariate analysis indicated that tumor diameter >4 cm,low differentiation,high PCI index,and preoperative CA19-9 >27 k U/L were risk factors for postoperative survival of gastric cancer patients with peritoneal metastasis(P <0.05).Cox multivariate analysis adjusted for confounding factors suggested that HIPEC could reduce the risk of death in patients with gastric cancer with peritoneal metastasis(P=0.004),The 2-year mortality risk was 0.341 times that of the control group.3.There was no significant difference in KPS between the intervention group and the control group(P=0.602).Compared with the control group,fewer patients in the intervention group developed fever after surgery.There was no anastomotic stenosis or anastomotic leakage between the two groups,and there was no statistical significance between the two groups in terms of intestinal obstruction,lung infection and incision infection.Conclusion:1.In gastric cancer patients with limited peritoneal metastasis(PCI≤7),the application of h yperthermic intraperitoneal chemotherap y(HIPEC)can significantly improve the 1-year and 2-year survival rates of patients,and the survival curves of the two groups are statistically different compared with the control group.2.Tumor diameter >4 cm,low differentiation,high PCI index,and preoperative CA19-9 >27 k U/ L are risk factors affecting the survival rate of gastric cancer patients with peritoneal metastasis.The use of HIPEC can reduce the risk of death in patients.3.Peritoneal thermoperfusion did not increase the risk of affecting patients ’ postoperative qualit y of life.And does not increase the risk of anastomotic leakage,anastomotic stenosis,fever,intestinal obstruction,lung infection,incision infection.