Predictive Factors Improving Survival After Gastrectomy in Gastric Cancer Patients with Peritoneal Carcinomatosis

The aim of this study was to review prognosis following gastrectomy for gastric cancer patients with synchronous peritoneal carcinomatosis and to identify predictive factors for improving survival after gastrectomy in this setting. Records of all patients who underwent gastrectomy for gastric cancer with peritoneal dissemination in our center between 1993 and 2004 were reviewed. Data of 101 patients who underwent gastrectomy for gastric cancer with peritoneal dissemination were available. Peritoneal dissemination was classified as P1, metastasis to the adjacent peritoneum in 34 patients; P2, a few scattered metastases to the adjacent peritoneum in 13 patients; and P3, numerous metastases in 54 patients. Nineteen patients sustained 21 adverse events. Overall survival was significantly improved for those in the P1 and P2 groups compared with that for the P3 group (median of 18 months and 15 months vs. 9 months; P < 0.001). Seven factors were significant for overall survival: peritoneal carcinomatosis, peritoneal lavage cytology, macroscopic type, resection margin, extent of lymph node dissection, curative potential of gastric resection, and chemotherapy, including perioperative and postrecurrent chemotherapy. In multivariate analysis, two factors were identified as independently associated with poor survival: P3 disease (P = 0.002) and absence of chemotherapy (P = 0.009). Univariate analysis of gastric cancer patients with P1 or P2 carcinomatosis revealed only tumor differentiation to be significant. Gastric cancer patients with P1/P2 carcinomatosis and well/moderately differentiated tumors are likely to have an improved survival after gastrectomy. We emphasize that patients with good performance status and P1/P2 carcinomatosis should be considered appropriate surgical candidates before embarking on palliative systemic chemotherapy alone.