Extensive intraoperative peritoneal lavage and chemotherapy for gastric cancer patients with peritoneal free cancer cells

Shimada, Shinya; Tanaka, Eiji; Marutsuka, Takashi; Honmyo, Ubehiko; Tokunaga, Hidehiro; Yagi, Yasushi; Aoki, Norimitsu; Ogawa, Michio

doi:10.1007/s101200200029

Cited by 62 publications

(56 citation statements)

References 13 publications

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“…Shimada et al [74] in 2001 reported in a comparative non-randomized trial about the effects of intraoperative peritoneal lavage either associated or not with intraperitoneal chemotherapy for gastric cancer with free peritoneal cancer cells. Patients treated by intraoperative peritoneal lavage followed by intraperitoneal chemotherapy showed improved survival compared to patients treated by surgery alone or by surgery plus intraperitoneal lavage.…”

Section: Management Of Primary Gastric Cancer With Positive Peritoneamentioning

confidence: 99%

Gastric cancer: prevention and treatment of peritoneal metastases

Sugarbaker¹

2018

JCMT

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Gastric cancer is an aggressive malignancy that may metastasize through the bloodstream to the liver, through lymphatics to regional lymph nodes, or by penetration of the peritoneal lining of the stomach to result in seeding of the abdominal and pelvis surfaces. Peritoneal metastases are the most common mode of cancer dissemination. Technologies to prevent or treat peritoneal metastases from advanced gastric cancer are presented in this manuscript. The world's literature, both recent and over the past three decades, was reviewed in order to identify publications that present information regarding gastric cancer peritoneal metastases. Over one dozen randomized controlled trials to test perioperative chemotherapy for prevention of peritoneal metastases were reviewed. All of the trials performed with regional chemotherapy during or shortly after gastrectomy were positive. The clinical data regarding the treatment of peritoneal metastases diagnosed at the time of primary cancer resection or in follow-up were reviewed. Neoadjuvant intraperitoneal and systemic chemotherapy shows that some long-term survivors occur after these treatments were combined with cytoreductive surgery and gastrectomy. Similar treatments are advocated for primary gastric cancer with cytology positive for gastric cancer but no visible implants. Surgery for gastric cancer should be combined with perioperative systemic and regional chemotherapy in order to maximally benefit patients with this disease by reducing the negative impact of peritoneal metastases on survival.

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Section: Management Of Primary Gastric Cancer With Positive Peritoneamentioning

confidence: 99%

Gastric cancer: prevention and treatment of peritoneal metastases

Sugarbaker¹

2018

JCMT

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“…In addition, there were four prospective cohort studies [10][11][12][13] with one remaining retrospective cohort study [14].…”

Section: Quality Of Studiesmentioning

confidence: 99%

“…This study, by Kodera et al, lacks any information on baseline characteristics of the control group, and there were limited outcome data for this group. Moreover, one prospective cohort study [11] provided no information on the baseline characteristics of the intervention and control arms. Concerning harm, most studies reviewed the complications of therapy, with the exception of three studies [9][10][11].…”

Section: Quality Of Studiesmentioning

confidence: 99%

“…Moreover, one prospective cohort study [11] provided no information on the baseline characteristics of the intervention and control arms. Concerning harm, most studies reviewed the complications of therapy, with the exception of three studies [9][10][11]. ss subserosa, se serosa-exposed, si serosa-infiltrating, RT-PCR reverse transcriptase-polymerase chain reaction, CEA carcinoembryonic antigen, EIPL extensive intraperitoneal lavage, IPC intraperitoneal chemotherapy, tub2 moderately differentiated type tubular adenocarcinoma, por2 nonsolid type of poorly differentiated adenocarcinoma, sig signet ring-cell carcinoma, NS not stated…”

Section: Quality Of Studiesmentioning

confidence: 99%

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A systematic review and meta-analysis of gastric cancer treatment in patients with positive peritoneal cytology

et al. 2014

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Gastric cancer patients with positive peritoneal cytology as the only marker of metastatic disease have poor prognoses. There is no universal consensus on the most appropriate treatment regimen for this particular patient group. We reviewed and analyzed published data to determine the optimal treatment regimen for patients with peritoneal cytology-positive gastric adenocarcinomas. Six electronic databases were explored [PubMed, Cochrane (Systematic Reviews and Controlled Trials), PROSPERO, DARE, and EMBASE]. The primary outcome was overall survival with secondary outcomes including patterns of recurrence and treatment-related morbidity. Six studies were included for data extraction. There was no significant heterogeneity between studies. The use of S1 monotherapy was associated with a significant survival benefit (HR 0.48; 95 % CI 0.32-0.70; p = 0.0002). Intraoperative intraperitoneal chemotherapy (IIPC) with adjuvant chemotherapy showed a trend toward improvement in overall survival (HR 0.70; 95 % CI 0.47-1.04; p = 0.08). A recent randomized controlled trial examining extensive intraperitoneal lavage (EIPL) with IIPC showed a significant improvement in overall survival (5-year overall survival, 43.8 % for EIPL-IPC group compared with 4.6 % for IPC group). However, these promising results need to be validated in larger prospective randomized trials.

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“…For the prevention of peritoneal recurrence, Shimada and colleague [62,63] reported that extensive intraoperative peritoneal lavage (EIPL) followed by IPC is useful for eradicating free cancer cells in the peritoneal cavity and micrometastases on the peritoneal surface. Because free cancer cells may be reduced to almost zero using this method, treatment evaluation would not be influenced by differences of the number of free cancer cells between patients.…”

Section: Prophylactic (Adjuvant) Chemotherapymentioning

confidence: 99%

Intraperitoneal Chemotherapy as a Multimodal Treatment for Gastric Cancer Patients with Peritoneal Metastasis

Fushida¹,

Oyama²,

Koyama³

et al. 2013

JCT

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Peritoneal metastasis of gastric cancer is mainly caused by the dispersion of free cancer cells from the serosal surface of the invaded stomach, from surgically transected lymphatic channels, and from tumor cell-containing blood from the primary lesion into the peritoneal cavity. Intraperitoneal chemotherapy (IPC) combined with surgery has performed for the prevention and treatment of peritoneal metastasis in gastric cancer. The efficacy of this technique is influenced by the pharmacokinetic advantage achievable with the anticancer drug, timing of administration, combination with hyperthermia, and tumor volume. The pharmacokinetic advantage for peritoneal cavity exposure relative to peripheral circulation by intraperitoneal delivery for drugs including cisplatin (10-fold advantage), mitomycin C (20-to 30-fold advantage), docetaxel (500-fold advantage), and paclitaxel (1000-fold advantage) has been confirmed. To avoid uneven drug distribution in the peritoneal cavity and the re-growth of residual tumor, it seems to be reasonable to perform IPC perioperatively; however, early perioperative intraperitoneal chemotherapy (EPIC) has a relatively high morbidity rate compared with intraoperative IPC. Hyperthermia has both cytotoxicity of itself and a synergistic effect with anticancer drugs, especially mitomycin C. In the adjuvant setting, patients with either hyperthermic intraperitoneal chemotherapy (HIPEC) or EPIC showed a significant improvement of survival compared to those with surgery alone. In addition, extensive intraoperative peritoneal lavage (EIPL) seems also to be a reasonable method to reduce free cancer cells in the peritoneal cavity. For the treatment of peritoneal metastasis, cytoreductive surgery which achieves R0 or R1 resection followed by IPC has demonstrated a survival benefit, whereas gross residual tumor (R2) treated by IPC has shown poor prognosis. Extensive cytoreductive surgery, such as peritonectomy, followed by IPC achieved long-term survival for selected patients, though this aggressive procedure led to high morbidity and mortality rates. It seems that combined chemotherapy (systemically and intraperitoneally) followed by conversion surgery can be expected to be a powerful procedure for the patients with gross peritoneal tumors.

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Extensive intraoperative peritoneal lavage and chemotherapy for gastric cancer patients with peritoneal free cancer cells

Cited by 62 publications

References 13 publications

Gastric cancer: prevention and treatment of peritoneal metastases

Gastric cancer: prevention and treatment of peritoneal metastases

A systematic review and meta-analysis of gastric cancer treatment in patients with positive peritoneal cytology

Intraperitoneal Chemotherapy as a Multimodal Treatment for Gastric Cancer Patients with Peritoneal Metastasis

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