title: Extensive intraoperative peritoneal lavage and chemotherapy for gastric cancer patients with peritoneal free cancer cells.
abstract: The effects of extensive intraoperative peritoneal lavage (EIPL) for gastric cancer patients with peritoneal free cancer cells were investigated. This study was based on 22 consecutive patients with peritoneal free cancer cells, among 663 patients who underwent curative surgical treatment for advanced gastric cancer. The 22 patients were followed up for 2 years or until death. These patients were divided into three groups: group 1, patients with no additional intraoperative therapy (from 1989 to 1992; n = 8); group 2, patients with intraoperative intraperitoneal chemotherapy alone (from 1992 to 1995; n = 7); and group 3, patients with EIPL followed by intraoperative intraperitoneal chemotherapy (from 1996 to 1999; n = 7). Reverse transcriptase-polymerase chain reaction (RT-PCR) analysis showed that viable cancer cells were not detected after the eighth EIPL in a gastric cancer patient with numerous intraperitoneal free cancer cells. In group 3, 4 of the 7 patients survived for more than 2 years, including 3 with cancer-free status, whereas no patient survived cancer-free in groups 1 and 2. The peritoneal recurrence rates and cancer-specific 2-year survival rates in groups 1, 2, and 3 were 100%, 85.7% and 42.9%; and 0%, 14.3%, and 57.1%, respectively. The 2-year survival rate of group 3 was significantly higher than that of group 1 (P = 0.017) and that of group 2 (P = 0.025). In a subset analysis, patients with peritoneal free gastric cancer cells but no macroscopic dissemination showed a statistically significant improvement in survival those treated with EIPL compared with those not treated with EIPL.
authors.affiliation: Department of Surgery, Yatsushiro Health Insurance General Hospital, Kumamoto, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Shimada
authors.forename: Eiji
authors.initials: E
authors.lastname: Tanaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Marutsuka
authors.forename: Ubehiko
authors.initials: U
authors.lastname: Honmyo
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Tokunaga
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yagi
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Aoki
authors.forename: Michio
authors.initials: M
authors.lastname: Ogawa
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004358:Drug Therapy; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007430:Intraoperative Care; D007564:Japan; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D010533:Peritoneal Lavage; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin