title: Cytoreductive surgery and intraperitoneal chemohyperthermia for peritoneal carcinomatosis arising from gastric cancer.
abstract: OBJECTIVE
  The most common cause of palliative resection and recurrence in gastric cancer is peritoneal seeding. This study evaluates the efficacy of intraperitoneal chemohyperthermia after cytoreductive surgery in patients with peritoneal carcinomatosis arising from gastric cancer.
  
  
  METHODS
  Prospective clinical trial.
  
  
  METHODS
  Surgical department at a university academic hospital.
  
  
  METHODS
  Forty-nine consecutive patients with peritoneal carcinomatosis treated between January 1, 1989, and February 29, 2000.
  
  
  METHODS
  All patients underwent intraperitoneal chemohyperthermia with mitomycin C (40-60 mg); 21 patients had previously undergone extensive cytoreductive surgery.
  
  
  METHODS
  Clinicopathologic factors that affect overall survival rates.
  
  
  RESULTS
  With median follow-up of 99 months, overall median survival was 10.3 months. Two factors were significant independent predictors of survival by multivariate analysis: preoperative ascites (P =.04) and completeness of cancer resection (CCR) by cytoreductive surgery (P<.001). Median survival was 21.3 months for patients with CCR-0 (macroscopic complete resection) or CCR-1 (diameter of residual nodules <5 mm) and 6.1 months for patients with CCR-2 (diameter of residual nodules >5 mm) (P<.001). Four patients survived longer than 5 years.
  
  
  CONCLUSIONS
  An aggressive management strategy combining intraperitoneal chemohyperthermia with cytoreductive surgery is effective for patients with peritoneal carcinomatosis arising from gastric cancer. In highly selected patients (good general status, resectable primary tumor, resectable peritoneal carcinomatosis), this therapy may result in long-term survival.
authors.affiliation: Department of Surgery, Centre Hospitalier Lyon-Sud, Pierre Bénite, France.
authors.forename: O
authors.initials: O
authors.lastname: Glehen
authors.forename: V
authors.initials: V
authors.lastname: Schreiber
authors.forename: E
authors.initials: E
authors.lastname: Cotte
authors.forename: A C
authors.initials: AC
authors.lastname: Sayag-Beaujard
authors.forename: D
authors.initials: D
authors.lastname: Osinsky
authors.forename: G
authors.initials: G
authors.lastname: Freyer
authors.forename: Y
authors.initials: Y
authors.lastname: François
authors.forename: J
authors.initials: J
authors.lastname: Vignal
authors.forename: F N
authors.initials: FN
authors.lastname: Gilly
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D011446:Prospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D016685:Mitomycin