Positive Results of Combined Therapy of Surgery and Intraperitoneal Hyperthermic Perfusion for Far-advanced Gastric Cancer

Abstract

To evaluate the clinical efficacy of intraperitoneal hyperthermic perfusion (IPHP) for far-advanced gastric cancer, particularly with peritoneal seeding, we investigated the survival times of 59 patients who underwent distal subtotal gastrectomy, total gastrectomy, or total gastrectomy combined with concomitant resection of some of the remaining intra-abdominal organs. In all the 30 patients given IPHP, no cancer cells were present posthyperthermically in the lavage from the Douglas pouch. The 30 patients given IPHP lived longer than the 29 patients not given IPHP (p = 0.001), with a 1-year survival rate of 80.4% in the former group compared to 34.2% in the latter. With respect to a comparison of survival time of patients with peritoneal seeding, 7 patients not given IPHP had a 6-month survival rate of 57.1% and did not survive more than 9 months, whereas 20 patients given IPHP had 1- and 2-year survival rates of 78.7% and 45.0%, respectively; here the difference was significant (p = 0.001). The IPHP and control groups without peritoneal metastasis included 10 and 22 patients, respectively, and the 1-year survival rates are 85.4% and 45.3%, respectively. The survival rates of the former exceeded those of the latter, with p = 0.015 by the generalized Wilcoxon test. Thus this combined therapy offers the promise of extended survival for patients with far-advanced gastric cancer.

Pharmacokinetic and Pharmacodynamic Analysis of Hyperthermic Intraperitoneal Oxaliplatin-Induced Neutropenia in Subjects with Peritoneal Carcinomatosis

“…However, there are no PC treatment approved by regulatory agencies, and the development of new therapies to manage this life-threatening condition could fulfill an unmet medical need. In this context, several Phase I/II clinical studies in gastric cancer (1)(2)(3), mesothelioma (4), colorectal (5), or ovarian carcinoma (6) have shown promising results in treating macroscopic PC with cytoreductive surgery and residual PC with hyperthermic intraperitoneal chemotherapy (HIPEC) (7). The rationale for this treatment is based on experimental studies showing that drug penetration is limited to a few cell layers under the surface of the tumor (8), and consequently, intraperitoneal chemotherapy must be immediately administered after the cytoreductive surgery in order to achieve the maximal cytotoxic activity on residual tumor cells before they get trapped in the postoperative fibrin adhesions (9).…”

A critical analysis of the cytoreductive surgery with hyperthermic intraperitoneal chemotherapy combo in the clinical management of advanced gastric cancer: an effective multimodality approach with scope for improvement

“…Fujimoto et al (54) reported a prospective study of 59 patients, 32 of whom had advanced GC without PC who underwent curative surgery. The 2-year survival of the 10 patients who received HIPEC was significantly higher than that of the 20 patients who did not (56.5% vs. 12.9%, P=0.01).…”

Survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer: a systematic review

“…Since then, various Asian groups have gone on to investigate the use of HIPEC in the prophylactic setting [21,25,26,[83][84][85][86][87]. All of them have provided evidence to show that HIPEC in the prophylactic setting can reduce the incidence of peritoneal recurrence and improve survival.…”

“…The abstracts of these 145 articles were reviewed carefully and a further 42 articles had full text review. Ultimately, 17 articles were included in this review and summarized in Table 1 [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Of the 17 articles included in the review, 1 was a systematic review, 1 was a randomized controlled trial, 11 were prospective studies (7 case series, 4 case controls and 1 prospective randomized trial) and the remaining 4 were retrospective studies.…”