title: A comprehensive treatment for peritoneal metastases from gastric cancer with curative intent.
abstract: Recently, Peritoneal Surface Oncology Group International (PSOGI) developed a novel comprehensive treatment consisting of cytoreductive surgery (CRS) and perioperative chemotherapy (POC) for the treatment of peritoneal metastases (PM) from gastric cancer with curative intent. This article reviews the results of this treatment and verifies its indication. In this strategy, peritoneal cancer index (PCI) is determined by laparoscopy, and a peritoneal port is placed. Neoadjuvant bidirectional intraperitoneal/systemic chemotherapy (NIPS) is performed for 3 cycles, and then laparotomy is performed. Cytoreductive surgery with peritonectomy procedures and hyperthermic intraperitoneal chemoperfusion (HIPEC) are performed. Multivariate analyses showed that completeness of cytoreduction, pathologic response to NIPS and PCI level and cytologic status after NIPS, as independent prognostic factors. PCI less than cut-off level after NIPS, negative cytology after NIPS, and positive response to NIPS were identified as the indications for comprehensive treatment. Patients who hold these criteria should be considered as the candidates for CRS and HIPEC.
authors.affiliation: Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Shiga, Japan; NPO to Support Peritoneal Surface Malignancy Treatment, Oosaka, 600 8189, Japan. Electronic address: y.yonemura@coda.ocn.ne.jp.
authors.forename: Y
authors.initials: Y
authors.lastname: Yonemura
authors.affiliation: NPO to Support Peritoneal Surface Malignancy Treatment, Oosaka, 600 8189, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Canbay
authors.affiliation: Department of Peritoneal Surface Oncology, Beijin Shijitan Hospital of Capital Medical University, Beijin, 100038, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: General Surgery Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Coccolini
authors.affiliation: Dēpartement de Chirurgie Gēnerale, Centre Hospitalier Lyon-Sud Hospices Civils de Lyon, Universitē Lyon, 69495, France.
authors.forename: O
authors.initials: O
authors.lastname: Glehen
authors.affiliation: Center of Gastrointestinal Malignancies, Program in Peritoneal Surface Malignancies, MedStar Washington Hospital Center, Washington, DC, 20010, USA.
authors.forename: P H
authors.initials: PH
authors.lastname: Sugarbaker
authors.affiliation: Department of Surgery, St George Hospital, University of New South Wales, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Morris
authors.affiliation: Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals Foundation Trust, Adelmaston Road, Basingstoke RG24 9NA, UK.
authors.forename: B
authors.initials: B
authors.lastname: Moran
authors.affiliation: Department of Surgical Oncology, Peritoneal Surface Oncology Program, MD Anderson Cancer Center, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Gonzaletz-Moreno
authors.affiliation: National Cancer Institute of Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Deraco
authors.affiliation: Krankenhaus Barmherzige Brieder, Teaching Hospital of the University of Regensburg, Regensburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Piso
authors.affiliation: Département de Chirurgie Générale, Institut Gustave Roussy, Villejuif, Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Elias
authors.affiliation: Division of Surgical Oncology, Hillman Cancer Center, 5115 Centre Ave, Pittsburgh, PA, 15232, USA.
authors.forename: D
authors.initials: D
authors.lastname: Batlett
authors.affiliation: Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Shiga, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Ishibashi
authors.affiliation: Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Shiga, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Mizumoto
authors.affiliation: Oncologisch GE Chirurg, Catharina, Ziekenhuis Eindhoven, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Verwaal
authors.affiliation: Department of Surgical Sciences, Uppsala University, Övriga Samarbeten, Akademiska Sjukhuset, Ing 70 1 Tr, 751 85, Uppsala, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Mahtem
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D000077143:Docetaxel; D004338:Drug Combinations; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007263:Infusions, Parenteral; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D010094:Oxonic Acid / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D043823:Taxoids / Q000008:administration & dosage; D005641:Tegafur / Q000008:administration & dosage
chemical_list: D004338:Drug Combinations; D043823:Taxoids; C079198:S 1 (combination); D005641:Tegafur; D000077143:Docetaxel; D010094:Oxonic Acid; D002945:Cisplatin
keywords: Gastric cancer; HIPEC; NIPS; Peritoneal metastases; Peritonectomy