Extensive gastrectomy and carbon-adsorbed mitomycin C for gastric cancer with peritoneal metastases. Case reports of survivors and their implications.
OBJECTIVE
Extensive gastrectomy, defined as gastrectomy with complete omentectomy and extended lymphadenectomy, improves the survival of gastric cancer patients with peritoneal metastases, even though peritoneal metastasis is considered the end-stage of cancer. MMC-CH, a new dosage formulation of mitomycin C, extended the survival of rabbits with peritoneal carcinomatosis as compared to aqueous mitomycin C.


METHODS
We retrospectively reviewed 114 patients who underwent gastrectomy for gastric cancer with peritoneal metastases.


RESULTS
Six patients survived for more than 5 years after the therapy out of 63 patients treated with MMC-CH therapy and extensive gastrectomy for gastric cancer with P1, i.e., metastases to the adjacent peritoneum but no metastasis to the distant peritoneum, or P2, i.e., a few metastases to the distant peritoneum. However, there were no 5-year survivors in patients with P3, i.e., numerous metastases to the distant peritoneum, or in patients treated with incomplete omentectomy, limited lymphadenectomy and no MMC-CH therapy.


CONCLUSIONS
The results imply that gastric cancer patients with P1 or P2 have a possible chance to survive more than 5 years when treated with MMC-CH therapy and extensive gastrectomy.
Hagiwara
A
A
Surgery 1, Kyoto Prefectural University of Medicine, Japan.
Togawa
T
T
Yamasaki
J
J
Ohgaki
M
M
Imanishi
T
T
Shirasu
M
M
Sakakura
C
C
Yamaguchi
T
T
Sawai
K
K
Yamagishi
H
H
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D000327:Adsorption; D000328:Adult; D000368:Aged; D000818:Animals; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D002606:Charcoal; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004304:Dosage Forms; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage* / Q000009:adverse effects; D009852:Omentum / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D011817:Rabbits; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate
D000903:Antibiotics, Antineoplastic; D004304:Dosage Forms; D002606:Charcoal; D016685:Mitomycin