Clinical trial with surgery and intraperitoneal hyperthermic perfusion for peritoneal recurrence of gastrointestinal cancer

Abstract

To treat six patients with peritoneal recurrence after radical operation for gastrointestinal cancer, an intraperitoneal hyperthermic perfusion (IPHP), combined with surgical resection of recurrent tumors, intestinal bypass anastomosis, or both, was carried out. Immediately after complete resection of the intraperitoneal recurrent tumors, a 2-to 3-hour IPHP was performed under hypothermic general anesthesia at about 32"C, using a perfusate containing 10 pg/ml or 20 pg/ml of mitomycin C (MMC) warmed at the inflow temperature of 466°C to 469°C. The apparatus used for IPHP was designed for intraperitoneal perfusion as a closed circuit. Although five of the six patients had a malignant peritoneal effusion at the time of admission, the effusion disappeared soon after IPHP, and no cancer cell was present in the lavage from Douglas' pouch. The other patient had a recurrent tumor at the anastornotic region after low anterior resection for rectal cancer and complete resection of the recurrent tumor, combined with IPHP, was carried out. One patient with a recurrent gastric cancer died of hepatic metastasis and cancerous pleuritis 5 months after this treatment, and the other five are in good health 12.8 k 5.1 months after IPHP. On the other hand, five patients with intra-abdominal recurrent gastric cancer, who received only surgical treatment within the same period of time, died 3.0-t 2.1 months after the surgery. Postoperatively, in the six patients with IPHP, transitory hepatic dysfunction, hypoproteinemia, and thrombocytopenia occurred. These results show that IPHP using MMC combined with surgery is a safe, reliable treatment for patients with peritoneal recurrence of gastrointestinal cancer. Cancer 64: 154-160,1989.

A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP)

“…Although thrombocytopenia and elevated serum GOT and GPT levels were observed in the CHPP group, the levels returned to within the normal range at the end of 2 weeks after CHPP. Fujimoto et al [9] observed that there was no evidence of peritoneal seeding at the time of the second intraperitoneal hyperthermic perfusion (IPHP) in 1 of 15 patients with far-advanced gastric carcinoma who had definite peritoneal seeding before the second IPHP. Fujimoto et al [10] also noted that IPHP with a closedcircuit system was a safe antitumor treatment for gastric carcinoma with peritoneal dissemination.…”

Book Reviews

“…Thermal probes were placed intraperitoneally and along the circuit to monitor perfusate temperature during the procedure. We performed HIIC according to either the “closed”25 or the “open” technique, the latter using a peritoneal cavity expander as reported by Fujimura et al,26 that allows the surgeon to gently but continuously manipulate the viscera to enhance drug diffusion within the abdominal cavity. Drugs were bolus‐injected into the circuit once an intraperitoneal temperature of 41.5 °C had been reached.…”

The role of HIPEC in the treatment of peritoneal carcinomatosis from gastric cancer

“…In the experience of Fujimoto [84], transitory hepatic dysfunction, hypoproteinemia, and thrombocytopenia occurred in all six patients undergoing CRS, and Stephens [85] found, in a series of 200 patients undergoing CRS and HIPEC with MMC, with the Coliseum technique, major complications in 27% of patients and procedure-related complications in 1.5% of patients. Some authors have reported ureteral obstructions in up to 3.9% of patients as a complication of CRS + HIPEC, proposing a prophylactic urethral stenting [86].…”

“…Nutritional status has shown a significant prognostic value even in the study by Vashi The selection of patients for CRS plus HIPEC should be on the basis of the assessment of nutritional status and detection of ascites [53]. Nevertheless, many authors have reported the disappearance of ascites after HIPEC, although not affecting the survival [25,48,55].…”

“…All 11 patients developed neoplastic ascitis, but those who underwent HIPEC did not experience recurrence of effusion whereas three patients from the control group experienced recurrence rapidly after the treatment [55]. MMC was administered in both groups: at a dose of 10 μ/ml at an inflow temperature of 46.5 1.1°C in the HIPEC group and 10 mg in the control group.…”