Cytoreductive surgery and intraperitoneal chemohyperthermia for peritoneal carcinomatosis arising from gastric cancer.
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.
Glehen
O
O
Department of Surgery, Centre Hospitalier Lyon-Sud, Pierre Bénite, France.
Schreiber
V
V
Cotte
E
E
Sayag-Beaujard
A C
AC
Osinsky
D
D
Freyer
G
G
François
Y
Y
Vignal
J
J
Gilly
F N
FN
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
D016685:Mitomycin