A Clinical Pilot Study Combining Surgery with Intraoperative Pelvic Hyperthermochemotherapy to Prevent the Local Recurrence of Rectal Cancer

Abstract

Intraoperative pelvic hyperthermochemotherapy (IOPHC) with mitomycin C (MMC) was prescribed for 14 patients with resectable advanced rectal cancer in an attempt to prevent a postoperative local recurrence. Immediately after rectal amputation and extended lymphadenectomy, IOPHC was performed using physiologic saline containing 40 micrograms/mL of MMC at 45.5 +/- 0.6 C for 90 minutes, with an apparatus devised for IOPHC. At the end of IOPHC, the esophageal temperature was 37.2 +/- 0.8 C and cooling was not required. Antitumor efficacy and complications in the IOPHC group were compared with findings in 12 rectal cancer patients who underwent surgery only within the same period of time. Operation time was not prolonged with IOPHC treatment. In cytologic examinations of the pelvic lavage just before IOPHC treatment, viable cancer cells were detected in 6 of the 14 patients but were never detected in the postoperative exudate drained from the pelvic cavity. Of the 12 patients in the control group, 2 had a local recurrence, while in the IOPHC group there was no local recurrence for 16.9 +/- 9.7 months at this writing. Postoperative complications did not differ between the groups. This IOPHC treatment is a favorable method in eradicating cancer cells for postoperative local recurrence of rectal cancer.

Prophylaxis with intraoperative chemohyperthermia against peritoneal recurrence of serosal invasion‐positive gastric cancer

“…Recently, several investigators reported that intraoperative chemohyperthermia is effective for treating the peritoneal dissemination of gastrointestinal cancer [22][23][24]. Direct introduction of heat plus anticancerous drugs into the peritoneal cavity seems judicious because it acts directly on peritoneal dissemination with high extracellular concentration and low drug transition to the peripheral vein [25].…”

Intraperitoneal chemotherapy for colorectal cancer

“…Fujimoto et al [124] applied HIPEC with MMC limited to the pelvis as adjuvant treatment in 14 patients with resectable advanced rectal cancer, resulting in low local recurrence rate. After a median follow-up of 17 months there was no recurrence in these 14 patients, while in a nonrandomized control group of 12 patients two local recurrences occurred.…”

Relation between Clinical and Histologic Outcome of Intraperitoneal Hyperthermic Perfusion for Patients with Gastric Cancer and Peritoneal Metastasis

“…While peritoneal seeding from gastric cancer is an irre versible and fatal process, intraperitoneal chemotherapy has been reported to lead to a favorable prognosis in patients with a small volume of cancerous tissues re stricted to the peritoneal surface [1], In vitro studies [2] indicate that concentrations of drugs retained in the pel vic cavity [3] are adequate to kill colorectal cancer cell lines. Fujimura et al [4] and Fujimoto et al [5][6][7] reported treatment protocols comprising the combined efficacy of aggressive surgery for advanced gastric cancer and enhanced tumoricidal activity of hyperthermia, based on the sustained concentration of antitumor drugs in the abdominal cavity.…”