Treatment Pathways and Outcomes in Unresectable Gastric Cancer: A Retrospective Cohort Analysis

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Research

Background:

• Advanced gastric cancer (AGC) management involves diverse surgical approaches.
• Strategies range from diagnostic surgery (DS) to palliative procedures (PP) and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).
• Real-world data on these strategies' impact on patient outcomes is crucial.

Purpose of the Study:

• To describe current surgical management strategies for AGC.
• To evaluate the impact of different surgical approaches on patient outcomes.
• To compare the effectiveness of DS, PP, and CRS-HIPEC in AGC.

Main Methods:

• Retrospective analysis of 158 AGC patients (2014-2024).
• Categorization into diagnostic surgery (DS, n=94), palliative procedures (PP, n=52), and CRS-HIPEC (n=12) groups.
• Comparison of demographic data, perioperative outcomes, and survival using statistical analyses (ANOVA, Chi-square, Kaplan-Meier).

Main Results:

• CRS-HIPEC patients were younger (mean 49.4 years) but had higher complication rates (75.0%) compared to PP (40.4%) and DS (7.4%).
• Median overall survival was significantly longer for CRS-HIPEC (40.3 months) versus PP (11.5 months) and DS (7.1 months).
• Disease-free survival in the CRS-HIPEC cohort was 16.6 months.

Conclusions:

• Surgical strategies for unresectable AGC are heterogeneous and require individualization.
• Palliative procedures offer symptom relief and modest survival gains in select patients.
• CRS-HIPEC shows promise for prolonged survival in highly selected cohorts, warranting further investigation.