The survival and peritoneal metastasis of hyperthermic intraperitoneal chemotherapy in advanced gastric cancer: a systematic review and meta-analysis of randomized controlled trials.

[BACKGROUND] About 20% of gastric cancer patients have peritoneal metastases diagnosed preoperatively or intraoperatively, and the median survival time of advanced patients with peritoneal metastases is only 3-6 months, with a 5-year survival rate of less than 2%. Some guidelines indicate that hyperthermic intraperitoneal chemotherapy (HIPEC) can be used in gastric cancer with limited peritoneal metastasis, which can effectively prolong survival and improve the quality of survival. However, HIPEC is controversial in preventing peritoneal metastasis.

[METHODS] This systematic review and meta-analysis study is reported according to the PRISMA 2020 and AMSTAR guidelines. The authors searched randomized controlled trials (RCTs) in PubMed, Cochrane Library, Web Of Science, and Embase until 1 April 2025 and applied methods used for high-quality systematic reviews. Clinical data including overall survival, disease-free survival, peritoneal recurrence rate, incidence of adverse reactions, and complications were analyzed using RevMan 5.4.

[RESULTS] Nine RCTs met the inclusion criteria (n = 1021 patients). Meta-analysis showed that the rate of peritoneal metastasis was significantly lower in the HIPEC group than in the control group (OR: 0.24; 95% CI: 0.16-0.35), the rate of distant metastasis was significantly lower in the HIPEC group (OR: 0.45, 95% CI: 0.28-0.71), the 3-year survival rate was prolonged in the HIPEC group compared with the control group (OR: 1.48; 95% CI: 1.01-2.17), the 3-year disease-free survival rate was significantly higher in the HIPEC group (OR: 1.92; 95% CI: 1.23-3.00), and HIPEC was not associated with an increased number of complications and adverse events.

[CONCLUSION] HIPEC has a favorable effect on prolonging survival and reducing peritoneal metastasis and distant metastasis in patients with advanced gastric cancer, and does not significantly increase adverse reactions and complications.