Successful intraperitoneal hyperthermic chemoperfusion for the prevention of postoperative peritoneal recurrence in patients with advanced gastric carcinoma.
BACKGROUND
The majority of advanced gastric carcinoma patients with serosal invasion die of peritoneal recurrence, even when a curative gastrectomy is performed, because peritoneal recurrence occurs due to intraperitoneal free tumor cells that detach from the serosal-invaded focus. In an attempt to prevent peritoneal recurrence, intraperitoneal hyperthermic chemoperfusion (IHCP) treatment was combined with aggressive surgery.


METHODS
Between March 1987 and December 1996, 141 gastric carcinoma patients with macroscopic serosal invasion were allocated randomly to 2 groups. Seventy-one patients underwent IHCP combined with surgery (IHCP group) and the remaining 70 patients underwent surgery alone (control group). IHCP was performed just after gastric resection and alimentary tract reconstruction under general anesthesia along with systemic hyperthermia.


RESULTS
Postoperative complications were reported in 2 of the 71 patients in the IHCP group and in 2 of the 70 patients in the control group. The peritoneal recurrence rate in the IHCP group was significantly decreased (P = 0.0000847) compared with that in the control group. The 2-year, 4-year, and 8-year survival rates for the IHCP group were 88%, 76%, and 62%, respectively, whereas those for the control group were 77%, 58%, and 49%, respectively. The IHCP group thus reaped a significant survival benefit (P = 0.0362) compared with the control group.


CONCLUSIONS
Although this study was conducted randomly for a small number of patients, compared with the control group, the IHCP group had a high survival rate and better prognosis.
Fujimoto
S
S
Department of Surgery, Social Insurance Funabashi Central Hospital, Funabashi, Japan.
Takahashi
M
M
Mutou
T
T
Kobayashi
K
K
Toyosawa
T
T
D002277:Carcinoma / Q000517:prevention & control* / Q000556:secondary / Q000601:surgery / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005751:Gastric Lavage / Q000379:methods; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010533:Peritoneal Lavage / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000517:prevention & control* / Q000556:secondary; D011446:Prospective Studies; D012008:Recurrence; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D015996:Survival Rate