The therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy achieved long-term survival in a selected group of patients with PC from colorectal origin with acceptable morbidity and mortality. The complete cytoreductive surgery was the most important prognostic indicator.

BackgroundThis randomized phase III study was to evaluate the efficacy and safety of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis (PC) from gastric cancer.MethodsSixty-eight gastric PC patients were randomized into CRS alone (n = 34) or CRS + HIPEC (n = 34) receiving cisplatin 120 mg and mitomycin C 30 mg each in 6000 ml of normal saline at 43 ± 0.5°C for 60–90 min. The primary end point was overall survival, and the secondary end points were safety profiles.ResultsMajor clinicopathological characteristics were balanced between the 2 groups. The PC index was 2–36 (median 15) in the CRS + HIPEC and 3–23 (median 15) in the CRS groups (P = 0.489). The completeness of CRS score (CC 0–1) was 58.8% (20 of 34) in the CRS and 58.8% (20 of 34) in the CRS + HIPEC groups (P = 1.000). At a median follow-up of 32 months (7.5–83.5 months), death occurred in 33 of 34 (97.1%) cases in the CRS group and 29 of 34 (85.3%) cases of the CRS + HIPEC group. The median survival was 6.5 months (95% confidence interval 4.8–8.2 months) in CRS and 11.0 months (95% confidence interval 10.0–11.9 months) in the CRS + HIPEC groups (P = 0.046). Four patients (11.7%) in the CRS group and 5 (14.7%) patients in the CRS + HIPEC group developed serious adverse events (P = 0.839). Multivariate analysis found CRS + HIPEC, synchronous PC, CC 0–1, systemic chemotherapy ≥ 6 cycles, and no serious adverse events were independent predictors for better survival.ConclusionsFor synchronous gastric PC, CRS + HIPEC with mitomycin C 30 mg and cisplatin 120 mg may improve survival with acceptable morbidity.

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The present meta-analysis indicates that HIIC with or without EPIC after resection of advanced gastric primary cancer is associated with improved overall survival. However, increased risk of intra-abdominal abscess and neutropenia are also demonstrated.

RML is a useful classification of patients with gastric cancer. It may prevent the phenomenon of stage migration.

The present study clearly revealed that EIPL-IPC therapy significantly improved the 5-year survival span of advanced gastric cancer patients with CY+/P-. Thus, EIPL-IPC therapy is strongly recommended as a standard prophylactic strategy for peritoneal dissemination.

We previously Isolated from a rat regeneratbig islet cDNA library a gene named Reg, which Is expressed in regenerating Islets but is not expressed in normal islets. Here we examined the effect of rat Reg protein on pancreatic beta-cell replication using both 90% depancreatized rats and isolated Islets. The depancreatized rats that received i. Hydrated 5-pm sections of paraffin-embedded pancreatic tissues were stained for insulin by the labeled streptavidinbiotin method, using an LSAB kit (Dakopatts, Glostrup, Denmark). After being stained, the relative volumes of beta cells were measured by the point-counting method (1, 13).In Vitro Experiment. Pancreatic islets were isolated from male Wistar rats (body weight 200-250 g) by using density separation on a dextran gradient and cultured free-floating in RPMI 1640 medium/10%o fetal calf serum/penicillin G at 100 pg/ml/streptomycin at 100 g/ml for 48 hr to allow recovery from the isolation procedure (14). After this initial period, islets were transferred to 24-well culture dishes in groups of 50 islets. The islets were cultured in RPMI 1640 medium/2.7 mM D-glucose/2% fetal calf serum/penicillin G at 100 ;g/ ml/streptomycin at 100 ;g/ml in the presence of increased concentrations of Reg protein for 72 hr. During the last 24 hr, the islets were cultured in the above medium to which [methyl-3H]thymidine at 10 puCi/ml (Amersham; 1 Ci = 37 GBq) had been added. To estimate the amount of [3H]thymidine incorporated into newly synthesized DNA, the islets were washed as described (14) after the culture period and sonicated in 10 mM Tris.HCl/5 mM EDTA. DNA was precipitated by the addition of 7% ice-cold trichloroacetic acid and trapped by filtration on a glass-fiber disc (Whatman GF/C). The discs were dried, and radioactivity was counted after the addition of scintillation fluid (Packard Ultima Gold F). The DNA content of the islets was measured by a flurometric DNA assay using Hoechst 33258. To estimate labeling indices for insulin-positive cells, the [3H]thymidinelabeled islets were fixed in 4% paraformaldehyde for 20 min and embedded in OCT compound. Ten-micrometer sections were cut with a cryostat and immunostained with antiporcine insulin guinea pig antiserum (DAKO, 1:500) and Vectastain ABC-GO kit (Vector Laboratories). Autoradiography of the immunostained sections was performed by using lTo whom reprint requests should be addressed at: