Complications and Management of an Implanted Intraperitoneal Access Port System for Intraperitoneal Chemotherapy for Gastric Cancer with Peritoneal Metastasis

Emoto, Shigenobu; Ishigami, Hironori; Hidemura, Akio; Yamaguchi, Hironori; Yamashita, Hiroharu; Kitayama, Joji; Watanabe, Toshiaki

doi:10.1093/jjco/hys129

Cited by 35 publications

(35 citation statements)

References 17 publications

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“…Complications associated with the port system occurred in 20.6% of 131 patients at our institution [40] . Inflow obstruction and infection were the main complications that occurred in 7.6% and 6.9% of patients, respectively.…”

Section: Peritoneal Access Port Systemmentioning

confidence: 80%

Breakthrough therapy for peritoneal carcinomatosis of gastric cancer: Intraperitoneal chemotherapy with taxanes

Yamaguchi¹

2015

WJGO

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The effect of chemotherapy on peritoneal carcinomatosis (PC) of gastric cancer remains unclear. Recently, the intraperitoneal (IP) administration of taxanes [e.g. , paclitaxel (PTX) and docetaxel (DOC)] during the perioperative period has shown promising results. Herein, we summarized the rationale and methodology for using IP chemotherapy with taxanes and reviewed the clinical results. IP administered taxanes remain in the IP space at an extremely high concentration for 48-72 h. The drug directly infiltrates peritoneal metastatic nodules from the surface and then produces antitumor effects, making it ideal for IP chemotherapy. There are two types of perioperative IP chemotherapy with taxanes: neoadjuvant intraperitoneal and systemic chemotherapy and sequential perioperative intraperitoneal chemotherapy (SPIC). In SPIC, patients receive neoadjuvant IP chemotherapy and the same regimen of IP chemotherapy after cytoreductive surgery (CRS) until disease progression. Usually, a taxane dissolved in 500-1000 mL of saline at ordinary temperature is administered through an IP access port on an outpatient basis. According to phase Ⅰ studies, the recommended doses (RD) are as follows: IP DOC, 45-60 mg/m 2 ; IP PTX [without intravenous (IV) PTX], 80 mg/m 2 ; and IP PTX (with IV PTX), 20 mg/m 2 . Phase Ⅱ studies have reported a median survival time of 14.4-24.6 mo with a 1-year overall survival of 67%-78%. A phase Ⅲ study comparing S-1 in combination with IP and IV PTX to S-1 with IV cisplatin started in 2011. The prognosis of patients who underwent CRS was better than that of those who did not; however, this was partly due to selection bias. Although several phase Ⅱ studies have shown promising results, a randomized controlled study is needed to validate the effectiveness of IP chemotherapy with taxanes for PC of gastric cancer. Core tip: Herein, we provided an overview on the recent advances in intraperitoneal (IP) chemotherapy using taxanes (e.g. , paclitaxel and docetaxel) for peritoneal carcinomatosis of gastric cancer. In particular, we focus on the rationale of IP chemotherapy with taxanes, treatment methodology, and results of current clinical studies. Intraperitoneally administered taxanes remain in the IP cavity for a long time, and they directly infiltrate the peritoneal metastatic nodule from the surface. Therefore, the repeated intra-abdominal administration of taxanes through an IP access port is needed to increase the antitumor effect of IP chemotherapy.

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Section: Peritoneal Access Port Systemmentioning

confidence: 80%

Breakthrough therapy for peritoneal carcinomatosis of gastric cancer: Intraperitoneal chemotherapy with taxanes

Yamaguchi¹

2015

WJGO

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“…Emoto et al reported that complications associated with the port system occurred in 20.6% of 131 patients in their study [24]. Inflow obstruction and infection were the main complications that occurred in 7.6 and 6.9% of the patients, respectively.…”

Section: Rationale and Methodology For Intraperitoneal Chemotherapymentioning

confidence: 87%

Intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis

Kobayashi

Kodera

2016

Gastric Cancer

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Peritoneal metastasis is the most frequent pattern of gastric cancer recurrence or metastasis and is a definitive determinant of prognosis. However, an effective means of treating peritoneal disease has not yet been established. Systemic chemotherapy has only a limited effect on peritoneal metastasis, although some progress has been shown in terms of median survival time, especially among patients with a minimal or moderate disease burden. Clinical research related to intraperitoneal administration of anticancer drugs is currently underway. An advantage of intraperitoneal chemotherapy is the ability to achieve high concentrations of anticancer drugs in the peritoneal cavity and the direct exposure of peritoneal deposits and free cancer cells to those drugs. In addition, pharmacokinetic studies with taxanes have shown that these high intraperitoneal drug concentrations are sustained for a considerable length of time, allowing prolonged exposure. As taxanes are the most appropriate drugs for intraperitoneal administration, the development of repeated intraperitoneal chemotherapy using taxanes for gastric cancer peritoneal metastasis-either alone or in combination with systemic chemotherapy-has taken place over the past decade, mostly in Japan. Several phase II trials and a phase III trial have recently demonstrated the efficacy of this therapy, including median survival times of 14.4-24.6 months and one-year overall survival rates of 67-91%. These results may lead to the approval of intraperitoneal taxanes, especially paclitaxel, for official insurance coverage in the near future.

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“…Schaeff et al reported six cases of PSM from gastric cancer, where five of the six patients underwent diagnostic laparoscopy with liver metastasis or peritoneal dissemination [14]. Our group previously reported that subcutaneous port-site metastasis was observed in 2 (1.5 %) of 131 patients who had peritoneal metastasis of gastric cancer and received intraperitoneal chemotherapy through an implanted subcutaneous infusion port [17]. PSM after laparoscopic gastrectomy has rarely been reported since the first case in 2007 [18].…”

Section: Psm After Laparoscopic Surgery For Gastric Cancermentioning

confidence: 93%

Port-site metastasis after laparoscopic surgery for gastrointestinal cancer

et al. 2016

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Although the incidence of port-site metastasis after laparoscopic surgery for colorectal cancer has markedly decreased since laparoscopic colectomy was first reported in 1991, it still has not reached zero. In colorectal cancer, the safety of laparoscopic surgery, including the low incidence of port-site metastasis, has been proven in large, randomized trials. In gastric cancer, reports of port-site metastasis are extremely rare, but we should await the results of ongoing trials. This brief review summarizes the current knowledge regarding port-site metastasis after laparoscopic surgery for colorectal and gastric cancer.

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Complications and Management of an Implanted Intraperitoneal Access Port System for Intraperitoneal Chemotherapy for Gastric Cancer with Peritoneal Metastasis

Abstract: Intraperitoneal chemotherapy for gastric cancer using a port is safe and feasible under appropriate management.

Cited by 35 publications

References 17 publications

Breakthrough therapy for peritoneal carcinomatosis of gastric cancer: Intraperitoneal chemotherapy with taxanes

Breakthrough therapy for peritoneal carcinomatosis of gastric cancer: Intraperitoneal chemotherapy with taxanes

Intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis

Port-site metastasis after laparoscopic surgery for gastrointestinal cancer

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