title: Clinical trial with surgery and intraperitoneal hyperthermic perfusion for peritoneal recurrence of gastrointestinal cancer.
abstract: To treat six patients with peritoneal recurrence after radical operation for gastrointestinal cancer, an intraperitoneal hyperthermic perfusion (IPHP), combined with surgical resection of recurrent tumors, intestinal by-pass anastomosis, or both, was carried out. Immediately after complete resection of the intraperitoneal recurrent tumors, a 2- to 3-hour IPHP was performed under hypothermic general anesthesia at about 32 degrees C, using a perfusate containing 10 micrograms/ml or 20 micrograms/ml of mitomycin C (MMC) warmed at the inflow temperature of 46.6 degrees C to 46.9 degrees C. The apparatus used for IPHP was designed for intraperitoneal perfusion as a closed circuit. Although five of the six patients had a malignant peritoneal effusion at the time of admission, the effusion disappeared soon after IPHP, and no cancer cell was present in the lavage from Douglas' pouch. The other patient had a recurrent tumor at the anastomotic region after low anterior resection for rectal cancer and complete resection of the recurrent tumor, combined with IPHP, was carried out. One patient with a recurrent gastric cancer died of hepatic metastasis and cancerous pleuritis 5 months after this treatment, and the other five are in good health 12.8 +/- 5.1 months after IPHP. On the other hand, five patients with intra-abdominal recurrent gastric cancer, who received only surgical treatment within the same period of time, died 3.0 +/- 2.1 months after the surgery. Postoperatively, in the six patients with IPHP, transitory hepatic dysfunction, hypoproteinemia, and thrombocytopenia occurred. These results show that IPHP using MMC combined with surgery is a safe, reliable treatment for patients with peritoneal recurrence of gastrointestinal cancer.
authors.affiliation: First Department of Surgery, School of Medicine, Chiba University, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Fujimoto
authors.forename: R D
authors.initials: RD
authors.lastname: Shrestha
authors.forename: M
authors.initials: M
authors.lastname: Kokubun
authors.forename: K
authors.initials: K
authors.lastname: Kobayashi
authors.forename: S
authors.initials: S
authors.lastname: Kiuchi
authors.forename: M
authors.initials: M
authors.lastname: Takahashi
authors.forename: C
authors.initials: C
authors.lastname: Konno
authors.forename: M
authors.initials: M
authors.lastname: Ohta
authors.forename: S
authors.initials: S
authors.lastname: Koike
authors.forename: Y
authors.initials: Y
authors.lastname: Kitsukawa
mesh_terms: D000328:Adult; D001798:Blood Proteins / Q000378:metabolism; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin; D008937:Mitomycins / Q000097:blood / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy*; D010976:Platelet Count
chemical_list: D001798:Blood Proteins; D008937:Mitomycins; D016685:Mitomycin