A new surgical approach (peritonectomy) for the treatment of peritoneal dissemination.
OBJECTIVE
Despite the improvements of chemotherapy and surgical techniques, treatment results of peritoneal dissemination still remain pessimistic.


METHODS
During a 10-year period, 106 patients with peritoneal dissemination from gastric cancer were treated with chemo-hyperthermic peritoneal perfusion (CHPP), peritonectomy + CHPP, systemic PMUE therapy, and surgery alone in 51, 15, 13, and 27 patients, respectively. In peritonectomy, disseminated nodules were resected as much as possible in combination with the combined resection of the abdominal organs and parietal peritoneum covering diaphragm, pelvis and abdominal wall. After resection, the abdominal cavity was treated with heated saline at 42-43 degrees, containing cisplatinum (CDDP), Mitomycin C (MMC), and etoposide for 1 hour. PMUE therapy was administered with one course of i.v. infusion of 75 mg/m2 of CDDP and 30 mg/body of MMC on the 1st day, followed by etoposide 50 mg/body on the 3rd, 4th, and 5th day, and with oral intake of 400 mg/body of UFT every day from the 1st day.


RESULTS
No post-operative or chemotherapeutic deaths were observed. Systemic PMUE therapy showed no survival improvement, and survival of the peritonectomy + CHPP group was the best, following CHPP, systemic PMUE and surgery alone.


CONCLUSIONS
Peritonectomy and CHPP may be the best choice for the treatment of peritoneal dissemination.
Yonemura
Y
Y
Surgery II, School of Medicine, Kanazawa University, Japan.
Fujimura
T
T
Fushida
S
S
Fujita
H
H
Bando
E
E
Nishimura
G
G
Miwa
K
K
Endou
Y
Y
Tanaka
M
M
Sasaki
T
T
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D006801:Humans; D006979:Hyperthermia, Induced; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery*; D013274:Stomach Neoplasms / Q000473:pathology*; D013514:Surgical Procedures, Operative / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents