Benefits of intra-operative systemic chemotherapy during curative surgery in patients with locally advanced gastric cancer.

Background: There is little information on the impact of intra-operative systemic chemotherapy on gastric cancer. The aim of this study was to identify prognostic factors in patients with locally advanced gastric cancer and undergoing curative resection, with a focus on evaluating survival benefits and tolerance of intra-operative systemic chemotherapy.

Methods: We retrospectively analyzed clinicopathological data for 264 consecutive patients who underwent curative resection for gastric cancer at Peking Union Medical College Hospital from January 2002 to January 2007. Survival curves were plotted using the Kaplan-Meier method and compared using log-rank tests. Univariate and multivariate analyses were performed with the Cox proportional hazard model.

Results: Patients who received intra-operative systemic chemotherapy had higher 5-year overall survival and 5-year disease-free survival rates (P = 0.019 and 0.010, respectively) than patients who did not receive intra-operative systemic chemotherapy. In the subgroup analysis, systemic intra-operative chemotherapy benefited the 5-year overall survival and disease-free survival rates for patients with cancer of stage pTNM IB-IIIB, but not stage pTNM IIIC. Patients who received intra-operative systemic chemotherapy in combination with post-operative chemotherapy had higher 5-year overall survival and 5-year disease-free survival rates (P = 0.046 and 0.021, respectively) than patients who only received postoperative chemotherapy. However, the difference in these rates between patients who received only intra-operative systemic chemotherapy and patients who only received curative surgery was not statistically significant (P = 0.150 and 0.170, respectively). Multivariate analyses showed that intra-operative systemic chemotherapy was a favorable prognostic factor for the overall survival and disease-free survival rates (P = 0.048 and 0.023, respectively). No grade 4 toxicities related to intra-operative systemic chemotherapy were recorded within the 4 weeks after surgery.

Conclusion: Intra-operative systemic chemotherapy during curative surgery may benefit patients with stage pTNM IBIIIB gastric cancer in terms of both overall survival and disease-free survival.