Efficacy and safety of sequential hyperthermic intraperitoneal chemotherapy following surgery for pathological T staging 4 gastric cancer

doi:10.3748/wjg.v32.i6.115556

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Feb 14, 2026; 32(6): 115556
Published online Feb 14, 2026. doi: 10.3748/wjg.v32.i6.115556

Efficacy and safety of sequential hyperthermic intraperitoneal chemotherapy following surgery for pathological T staging 4 gastric cancer

Wei-Long Lian, Li-Sheng Cai, Ming-Qiao Lian, Ming-Jie Lian, Yu-Qin Sun, Chen-Bin Lv, Guo-Ping Huang, Rong-Jie Huang, Yong-Bin Zhang, Wei-Ming Zeng, Qian-Hui Xu, Quan-Jian Zhu, Qiu-Xian Chen

Wei-Long Lian, Li-Sheng Cai, Ming-Qiao Lian, Ming-Jie Lian, Yu-Qin Sun, Chen-Bin Lv, Guo-Ping Huang, Rong-Jie Huang, Yong-Bin Zhang, Wei-Ming Zeng, Qian-Hui Xu, Quan-Jian Zhu, Qiu-Xian Chen, Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China

Author contributions: Lian WL wrote the original draft; Lian WL, Cai LS, and Chen QX designed the study; Lian WL, Lian MQ, Lian MJ, and Sun YQ were responsible for developing the methodology; Lian WL, Huang RJ, Zhang YB, Zeng WM, Xu QH, and Zhu QJ collected and analyzed data; Lian WL, Sun YQ, Lv CB, Huang GP, and Huang RJ performed statistical analysis; Cai LS, Sun YQ, and Chen QX participated in the review and editing; all authors approved the final version.

Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Zhangzhou Affiliated Hospital of Fujian Medical University (No. 2025 LWB196).

Informed consent statement: Informed consent was not required for this study because it only collected and analyzed data from past, completed medical treatments and does not involve any additional intervention, examination, or treatment of patients. The requirement for informed consent was waived by the study’s Institutional Review Board due to its retrospective nature.

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.

Data sharing statement: No additional data are available.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Qiu-Xian Chen, Associate Chief Physician, Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, No. 9 Zhangma Road, Yancuo Town, Longhai District, Zhangzhou 363000, Fujian Province, China. chenqiuxian2024@163.com

Received: October 21, 2025
Revised: November 17, 2025
Accepted: December 22, 2025
Published online: February 14, 2026
Processing time: 104 Days and 20.6 Hours

Abstract

BACKGROUND

Peritoneal metastasis influences prognosis and quality of life in patients with gastric cancer. The efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) as postoperative adjuvant therapy for advanced gastric cancer remains unclear.

AIM

To evaluate the efficacy and safety of HIPEC plus postoperative adjuvant chemotherapy (AC) for locally advanced gastric cancer.

METHODS

We analyzed 225 patients with gastric cancer who underwent radical surgery, categorized by those receiving HIPEC plus AC (HIPEC + AC group) and those receiving AC alone (AC group). Treatments were administered every other day, for a total of one to three sessions. Overall survival, disease-free survival (DFS), disease-free interval, peritoneal metastasis-free interval, and safety outcomes were compared between the groups. Survival analysis was performed using Kaplan-Meier curves with log-rank tests for group comparisons.

RESULTS

In total, 225 patients with non-metastatic pathological T staging 4 gastric adenocarcinoma were included (HIPEC + AC group, n = 96; AC group, n = 129). Propensity score matching balanced between-group baseline characteristics. The incidence of treatment-related adverse reactions did not differ significantly between groups. With median follow-up durations of 68.00 months (HIPEC + AC group) and 56.00 months (AC group), the HIPEC + AC group demonstrated better 3-year DFS (69.0% vs 50.0%) and longer disease-free interval and peritoneal metastasis-free interval. Three-year overall survival did not differ significantly (74.0% vs 65.0%). The median survival was 50 months in the AC group, but remained unreached in the HIPEC + AC group (cumulative survival > 50%).

CONCLUSION

HIPEC plus postoperative AC improves DFS and reduces peritoneal metastasis risk in non-metastatic pathological T staging 4 gastric adenocarcinoma without increasing adverse events, confirming its safety and efficacy in preventing recurrence and dissemination.

Keywords: Hyperthermic intraperitoneal chemotherapy; Gastric cancer; Prognosis; Overall survival; Disease-free survival; Disease-free interval; Peritoneal metastasis-free interval

Core Tip: The efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) as a postoperative adjuvant therapy for locally advanced gastric cancer remains unclear. This study analyzed 225 patients with nonmetastatic pathological T staging 4 gastric adenocarcinoma and found that HIPEC plus adjuvant chemotherapy significantly improved disease-free survival and reduced the risk of peritoneal metastasis without additional adverse reactions in non-metastatic pathological T staging 4 gastric adenocarcinoma. These results establish HIPEC as a safe and effective adjuvant therapy for preventing postoperative recurrence and peritoneal dissemination.