Hyperthermo‐chemotherapy combined with cytoreductive surgery for the treatment of gastric cancer with peritoneal dissemination

Abstract

Continuous hyperthermic peritoneal perfusion (CHPP) with anticancer agents (mitomycin C and cisplatin) in warm saline was performed in patients with peritoneal dissemination of gastric cancer following resection of the primary lesion. The effect of CHPP was examined by a second-look operation. This study includes 41 cases of gastric cancer with peritoneal dissemination but without liver metastasis treated during the past 6 years. The overall median survival was 14.6 months to 64.2 months from CHPP to death and the 3-year survival rate was 28.5%. Second look surgery revealed a remarkable diminution in the degree of peritoneal dissemination in 7 (50%) of 14 patients with disappearance of ascites after only one course of CHPP in 7 (77.8%) of 9 patients. Long-term 3 year-survival was noted in 4 (9.8%) patients on CHPP. Side effects were renal insufficiency in 2 (5%) patients, leukopenia in 2 (5%) patients, and perforation of the small intestine in 1 (2%) patient. These results suggest the effectiveness of CHPP in the treatment of gastric cancer with peritoneal dissemination.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Methodology, Drugs and Bidirectional Chemotherapy

“…Yonemura et al introduced a 'peritoneal access device' to achieve optimal peritoneal expansion. According to this technique, larger volumes of perfusion fluid can be added allowing the small bowel to float in the cavity expander [47]. A major advantage of these open techniques is the creation of controlled distribution of heat and the cytotoxic drugs however, disadvantages are also heat loss and possible drug leakage, increasing potential exposure to theatre staff [48].…”

Surgical treatment of disseminated peritoneal metastases from urological cancer: results from a prospective study

“…The mortality is < 6% and the 1-year survival 75%. Furthermore, ascites was controlled in 11 of 12, nine of 15 and seven of nine patients [18][19][20]. The present is the first prospective trial in patients with malignant ascites associated with peritoneal carcinomatosis in urological cancer.…”

The Role of Hyperthermic Intraperitoneal Chemotherapy in Gastric Cancer

“…None of the treatment options including repeated paracentesis, diuretics and systemic chemotherapy result in a permanent resolution of the ascites. Earlier reports of complete disappearance of ascites in patients with PM from gastric cancer who underwent HIPEC suggest its efficacy in this clinical setting [53,55]. Recently, laparoscopic HIPEC has been used to palliate patients with intractable ascites requiring repeated paracenteses [76,77].…”