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There is no standard treatment for peritoneal carcinomatosis (PC) from gastric cancer. New bidirectional chemotherapy (neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS)) was developed. The aim of the present study was to assess the safety and efficacy of NIPS and to show the selection for cytoreductive surgery on PC from gastric cancer. Seventy-nine patients with PC from gastric cancer were treated with NIPS. A peritoneal port system was introduced into the abdominal cavity. The peritoneal wash cytological examination through a port was done before and after NIPS. The patients were treated with oral TS-1 twice a daily for 21 days, followed by a 1-week rest. On day 1, 8, and 15 from the start of oral TS-1 administration, 30 mg/m 2 of Docetaxel and 30 mg/m 2 of cisplatinum with 500 ml of saline were introduced into the peritoneal cavity through the port. A median course of oral TS-1 was 2.1 course and a median time of IP chemoterapy was 5.8. Peritoneal free cancer cells (PFCCs) had been detected in 65 (82.2%) patients before NIPS, and the positive cytology changed to be negative in 41 (63.0%) patients after NIPS. After NIPS, 41 patients underwent laparotomy, and complete cytoreduction was done in 32 (78%) patients. Complete cytoreduction was done in 27 (51.9%) of 52 patients with negative cytology but in only 4 (14.8%) of 27 patients with positive cytology (P < 0.001). Patients with negative cytology after NIPS survived significantly longer than those with positive cytology. The adverse effects after NIPS were mild and there was no treatment-related deaths. The grade 3/4 hematological adverse effects were found in 2 (2.6%) patients. Grade 3 renal toxicity and port site infection was found in three patients, respectively. NIPS using a port system is a safe and effective treatment for PC. Peritoneal wash cytology through a port system is a good indicator to select the patients to perform cytoreductive surgery.

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Background. Even though cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are associated with a high morbidity and mortality rates, it has been reported that CRS and HIPEC improved survival of selected patients with peritoneal carcinomatosis. We aimed to report morbidity and mortality results of CRS and HIPEC from a single institution in Japan. Methods and Results. Total of 284 procedures of CRS were performed on patients with pseudomyxoma peritonei, peritoneal carcinomatosis (PC) from colon cancer and gastric cancer between 2007 and 2011 in our institution. The morbidity rate was 49% of all procedure, and grades I/II and grades III/IV complications were 28% and 17%, respectively. Most frequent complication was surgical site infections including intraabdominal abscess. The mortality rate was 3.5%, and reoperation was needed in 11% of all procedures. Univariate and multivariate analysis showed peritoneal carcinomatosis index (PCI) greater than 20 was the only significant factor for occurrence of postoperative complications (P < 0.01). In contrast, HIPEC significantly reduced postoperative complications (P < 0.05). Conclusions. The morbidity and mortality rates of our institution are comparable with previous reports that are in acceptable rates. Optimal patient selection such as patients with PCI less than 20 seems to be of paramount importance to CRS and HIPEC.

New azo-bridged ferrocene trimers, Fc-Fc'-N=N-Fc (2) and Fc-N=N-Fc'-N=N-Fc (3), where Fc and Fc' refer to (eta(5)-C(5)H(5))Fe(eta(5)-C(5)H(4)-) and Fe(eta(5)-C(5)H(4)-)(2), respectively, were obtained in the reaction of a mixture of lithioferrocene and 1,1'-dilithioferrocene with N(2)O. X-ray crystallography of azoferrocene (1) has determined that the Fe-Fe distance is 6.80 Å in the trans form. Cyclic voltammograms of 3 in aprotic solvents such as CH(2)Cl(2) or THF exhibit reversible 2e(-) and 1e(-) oxidation waves, indicating that the positive charge in the monocation is localized mostly on the terminal ferrocene unit (correspondingly, Fc(+)-N(2)-Fc'-N(2)-Fc) due to a strong electron-withdrawing effect of the azo group. This charge distribution in the mixed-valence state is supported by the characteristics of intervalence-transfer (IT) bands. An asymmetrical complex, 2, undergoes a three-step 1e(-) oxidation, and the two mixed-valence forms can be roughly expressed as Fc(+)-Fc'-N(2)-Fc and Fc(+)-Fc'-N(2)-Fc(+). The redox potentials and IT band characteristics of 1(+), 2(+), and 2(2+) depend markedly on the solvent. The solvent effect of the IT band on nu(max) cannot be interpreted only by the parameters in the Marcus-Hush theory, indicating that the nature of the solvent as donor or acceptor should be taken into account in the electron-exchange process in the mixed-valence states. More donating solvent affords higher IT and LMCT energy, indicating the hole-transfer mechanism. The reaction of 1,1'-dilithioferrocene and N(2)O gives a polymer composed of [-(Fc'-N=N-Fc')(0.6)-(Fc'-Fc')(0.4)-](n)().