Upper abdominal stop-flow perfusion as a neo and adjuvant hypoxic regional chemotherapy for resectable gastric carcinoma. A prospective randomized clinical trial.
OBJECTIVE
Gastric cancer remains a disease with a poor and dismal prognosis even after radical surgical resection. The present study attempts to clarify whether neo and adjuvant hypoxic upper abdominal chemotherapy can improve the survival of patients with gastric cancer undergoing radical surgical resection. Patterns of failure after surgery for gastric cancer include peritoneal seeding, resection margin recurrence, and liver metastasis.


METHODS
From October 1995 to February 1999, 58 patients with resectable gastric cancer were randomly assigned to three groups. Hypoxic upper abdominal chemotherapy was carried out using Mitomycin-C, 5-Fluorouracil, Leucovorin, and Farmorubicin, 10 days before surgery, and 20 days following surgery, in Group A (n=20) with or without in Group B (n=19) systemic chemotherapy; the remaining patients (Group C: n=19) had neither neo nor adjuvant treatment.


RESULTS
The 4-year survival of Group C patients was 29.2%. Group A patients (surgery plus hypoxic neo and adjuvant chemotherapy and systemic chemotherapy) had a 4-year survival of 45.5% versus a 4-year survival of 39.2% of Group B patients (surgery and hypoxic neo and adjuvant abdominal perfusion). Patients of all stages, histologically confirmed, were included in this study.


CONCLUSIONS
Patients suffering from gastric carcinoma have demonstrated statistically improved survival by combining resectional surgery with neo and adjuvant hypoxic upper abdominal perfusion and adjuvant systemic chemotherapy.
Lygidakis
N J
NJ
Athens Medical Center, Apollonion Hospital, Department of Surgical Oncology, Greece. igsc@compulink.gr
Sgourakis
G
G
Aphinives
P
P
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002408:Catheters, Indwelling; D015687:Cell Hypoxia / Q000187:drug effects; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000295:instrumentation*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D013274:Stomach Neoplasms / Q000098:blood supply / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate