Laparoscopic gastrectomy and adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) using a closed system with turbulent-flow circuit: technical aspects and preliminary results of a pilot study

Bernardi, Daniele; Asti, Emanuele; Punturieri, Michele; Luporini, Alberto; Bonavina, Luigi

doi:10.1007/s10353-018-0538-9

Cited by 3 publications

(2 citation statements)

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“…Since gastric cancer has the highest rate of peritoneal metastasis, prevention of peritoneal carcinomatosis is a critical need. In selected cases of PGC, laparoscopic surgery associated with hyperthermic intraoperative chemotherapy (HIPEC) has shown some benefit in reducing the risk of peritoneal recurrence [21,22] although the real mechanisms regulating peritoneal seeding of tumor cells from GI cancers still need to be better clarified [23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Perforated gastric cancer: a critical appraisal

et al. 2021

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Gastric cancer perforation is a life-threatening condition that accounts for less than 5% of all gastric cancer patients and typically requires emergency surgery. However, preoperative diagnosis is difficult and management has a dual purpose: to treat peritonitis and to achieve a curative resection. The optimal surgical strategy is still unclear and prognosis remains poor. A search of the literature was performed using MEDLINE databases (Pubmed, EMBASE, Web of Science and Cochrane) using terms such as “perforated gastric cancer”, “perforated gastric cancer and surgery”, “perforated gastric tumour” and “gastric cancer perforated”. Case reports, other reviews, non-english written papers and papers written before 2010 were excluded. Eight articles published between 2010 and 2020 matched the inclusion criteria for this review. Perforated gastric cancer was more prevalent in elderly males. Distal stomach was most frequently involved. Preoperative diagnosis was uncommon. Mortality rates ranged from 2 to 46%. Patients able to receive an R0 resection demonstrated better long-term survival compared with patients who had simple closure procedures. Laparoscopic procedure was mentioned only in one study. In an emergency situation, curative RO resection should always be offered in patients without multiple adverse factors. A surgical strategy using laparoscopic local repair as first step of surgery to resolve the peritonitis followed by a radical open or laparoscopic gastrectomy with lymphadenectomy could be considered. A balance between emergency and oncological needs should drive the surgical choice on a case by case basis.

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Section: Discussionmentioning

confidence: 99%

Perforated gastric cancer: a critical appraisal

et al. 2021

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“…We decided to offer to our patient the chance of a radical gastrectomy with adjuvant HIPEC in an attempt to reduce the risk of recurrence of peritoneal cancer [ 4 , 10 ]. In our experience with adjuvant HIPEC, the closed abdomen technique using the CO 2 recirculation system results in safe and effective treatment because of the constant temperature and the homogeneous distribution of the chemotherapy perfusate [ 5 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Drainage of a Subphrenic Abscess Followed by Two-Stage Gastrectomy and Adjuvant Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Perforated Gastric Carcinoma: A Case Report

et al. 2018

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Patient: Male, 65Final Diagnosis: Gastric carcinomaSymptoms: Abdominal and/or epigastric painMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Unusual clinical courseBackground:Perforated gastric cancer accounts for less than 1% of patients who present with an acute abdomen and for up to 16% of all gastric perforations. A two-stage laparoscopic procedure may be the therapeutic strategy of choice in selected patients, and adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) can reduce the incidence of peritoneal recurrence. A rare case of subphrenic abscess and gastric perforation due to carcinoma of the gastric fundus, followed by two-stage gastrectomy and adjuvant HIPEC is presented.Case Report:A 65-year old man presented with a left subphrenic abscess secondary to perforated gastric carcinoma. Laparoscopic drainage of the abscess was performed. Ten days later, following recovery from sepsis, the patient underwent total laparoscopic gastrectomy, and adjuvant HIPEC followed by a Roux-en-Y esophagojejunostomy. Histopathology showed an intestinal-type gastric adenocarcinoma. The tumor was staged as pT4aN0. The postoperative course was uneventful except for transient atrial fibrillation. The patient was discharged home on postoperative day 11. Systemic adjuvant chemotherapy was begun one month later. At six-month follow-up, the patient had no discomfort on eating or any other symptoms.Conclusions:In this case, a two-stage laparoscopic treatment for perforated gastric carcinoma combined with adjuvant HIPEC was feasible and safe and may be considered at the time of laparoscopic gastrectomy in selected patients with perforated gastric carcinoma.

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