Continuous hyperthermic peritoneal perfusion (CHPP) with a solution that contains mitomycin C (CHPP-M) has been clinically introduced as a prophylactic treatment for peritoneal recurrence of gastric cancer with serosal invasion. Two studies, each with a treated and a control group, were performed. In the historical control study the postoperative 3-year survival rate of patients (73.7%) in the treated group (n = 38) was significantly higher than the survival rate (52.7%) of those in the control group (n = 55) (P less than 0.04). In the random control study the survival rate (83%) of patients in the treated group (n = 26) was also higher than that (67.3%) of those in the control group (n = 21) in the 30 months that followed gastric surgery. However, there was no significant difference. In the historical control study with respect to the postoperative complications, anastomotic leak was observed in 8.5% of patients who were given CHPP-M and 12.8% patients who did not have CHPP-M. In the random control study anastomotic leak was observed in 3.1% of patients who had CHPP-M and 7.1% of patients who did not have CHPP-M. The incidence of adhesive ileus in patients having CHPP-M did not increase in historical or random control groups. Postoperative prolonged intestinal paresis or chemical peritonitis were not induced by CHPP-M. These results indicate that CHPP-M is a simple, safe, and readily available prophylactic therapy for peritoneal recurrence that may follow gastric cancer surgery.

Background. Continuous hyperthermic peritoneal perfusion (CHPP) with a solution that contained 10 μg/ml mitomycin C was devised initially as a method for intraperitoneal thermochemotherapy. The authors conducted a randomized clinical trial to evaluate the efficacy of CHPP as a prophylactic treatment for prevention of peritoneal recurrence of gastric cancer with serosal invasion. Methods. Between January 1983 and October 1986, 82 patients with gross serosal invasion but no gross peritoneal metastasis were divided by random sampling into two groups before undergoing potentially curative surgery for gastric cancer: 42 patients were scheduled to receive CHPP, whereas 40 were not scheduled to receive this treatment. CHPP was administered immediately after closing the abdomen after gastric resections while the patients were still on the operating table under general anesthesia. Results. The 5‐year survival rate (64.2%) of patients in the CHPP group was higher than that (52.5%) of patients in the control group although the difference was not significant. Of several patterns of cancer recurrence, peritoneal recurrence was more frequent in the control group than in the CHPP group. The mortality rate from peritoneal recurrence in the case of patients in the CHPP group was much lower than that of patients in the control group (P = 0.0854). CHPP did not induce anastomotic breakdown or chemical peritonitis after surgery. Conclusions. The results indicate that CHPP is effective in preventing peritoneal recurrence of gastric cancer with serosal invasion, which is highly likely to reappear in the peritoneum.

Background. The microwave tissue coagulator (2450 MHz) has been used clinically in the treatment of hepatocellular carcinoma (HCC) to transection of the liver parenchyma and has proven an excellent method for hemostasis. There are, however, few reports on the application of this coagulator to the induction of tumor necrosis. Methods. Microwave tissue coagulation (MTC) was applied at laparotomy in eight patients with nonresectable multiple HCCs. All patients were treated with a combination of resection or intrahepato‐arterial chemotherapy and MTC. A total of 222 bouts of MTC were applied to 21 tumors, the largest of which was 65 mm in largest dimension. The monopolar needle electrode was inserted directly into the tumor and the procedure was repeated at approximately 5 mm intervals. Results. Levels of alpha‐fetoprotein in serum were found to have decreased in all patients one month after surgery with MTC. Contrast‐enhanced computerized tomography (CT) showed the complete absence of blood flow in all tumors subjected to MTC. Needle biopsy one month after MTC confirmed tumor necrosis in all cases. All patients are alive at the time of this report, with the longest survival period being 24 months. In three of eight patients, new tumors were confirmed by angiographic CT at sites separate from the treated tumors. MTC resulted in fewer adverse effects on liver function and less extensive inflammatory reactions than liver resection. Conclusion. Intraoperative MTC appears to be an effective method for inducing local tumor necrosis, and may be of use in combination with palliative surgery for multiple HCC when radical liver resection is not feasible. Cancer 1995;75:794‐800.

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Carcinoembryonic antigen (CEA) levels were determined in 252 gastric cancer patients. In patients with resectable cancer, the preoperative CEA values and CEA positivity rates were 2.4 ± 1.5 ng/ml and 7.7% for stage I, 24.9 ± 72.0 ng/ml and 10.0% for stage II, 21.6 ± 84.1 ng/ml and 17.9% for stage III, and 6.3 ± 8.4 ng/ml and 27.1% for stage IV cancers, respectively. In patients with nonresectable cancers, the CEA value was 83.0 ± 235.5 ng/ml, the CEA positivity rate was 47.8%. Overall, of 252 patients with primary gastric cancer, 47(18.7%) were positive for CEA. In patients with cancer recurrence, the CEA value averaged 41.8 ± 101.8 ng/ml, the positivity rate was 63%. This rate increased as the cancer stage increased; it was highest in gastric cancer patients with liver metastasis. In 4 of 13 patients with recurrence, an elevation in CEA was observed about 4.8 months before the clinical detection of cancer recurrence. Our results suggest that in gastric cancer patients, the preoperative and periodic postoperative assay of CEA levels has predictive value in determining cancer stage, progression and recurrence.