Effects of Laparosopic Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis from Gastric Cancer

Abstract

Background: The purpose of this manuscript is to report the direct effects of hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer-patients with peritoneal metastasis (PM). Materials and Methods:Thirty-five patients with PM were enrolled, and were treated with neoadjuvant laparoscopic HIPEC (LHIPEC). LHIPEC was performed at 42 to 43 centigrade for 60 minutes adding 3 liter of saline plus 12.5mg/m2 of Mitomycin C with Cisplatin (50mg/m 2 ). Second session of LHIPEC was done one month after the first LHIPEC in all cases. At the second session of LHIPEC, ascites volume, peritoneal cytology and peritoneal cancer index (PCI) were examined again.Results: Intraoperative complications of bowel injury were experienced in one and three at 1 st and 2 nd session of laparoscopy, respectively. There was no mortality after LHIPEC. Ascites was completely disappeared in 17 of 34 patients at the second session of laparoscopy. PFCCs had been detected in 28 (80.0%) patients at the 1 st session, and the positive cytology changed to be negative in 16 (57.1%) of 28 patients at the second session. PCI at the 2 nd session (12.5 ± 10.5) was significantly lower than that at the 1 st session (16.8 ± 9.6) (P=0.023). PCI levels at the 2 nd session changed to be 0 in 6 patients. Conclusion:This new method is not only a safe and convenient method for predicting feasibility of complete cytoredution, but also an effective treatment to control malignant ascites and to eradicate PFCCs before cytoreductive surgery. Furthermore, LHIPEC can reduce PCI levels.

Effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion and intraperitoneal/systemic chemotherapy on peritoneal metastasis from gastric cancer

“…Outcome after CRS is reported to significantly correlate with negative peritoneal cytology than with positive peritoneal cytology. 18 Multivariate analysis in the present study also demonstrated the cytologic status after NLHIPEC plus NIPS (but not at NLHIPEC) as an independent prognostic factor.…”

“…Yonemura et al first reported the direct effect of NLHIPEC with or without NIPS on PCI determined by laparoscopy in 2016, and they found that neoadjuvant chemotherapy reduced PCI below its cut-off level in half of their patients. 18 Coccolini et al reported that PCI cut-off level at laparotomy is an independent prognostic factor after CRS. 19 However, which PCI cut-off (Pre-PCI vs Post-PCI cut-off) relates to prognosis remained unclear.…”

Surgery with hyperthermic intraperitoneal chemotherapy after response to induction chemotherapy in patients with peritoneal metastasis of gastric cancer

“…Previously, we reported that the bidirectional chemotherapy with cisplatin and docetaxel had effects on cytology, ascites status and PCI (7). We have also studied in vivo pharmacokinetics of docetaxel in 11 patients (25).…”

Recent advances in the treatment of peritoneal metastasis from gastric cancer

“…HIPEC increased the depth of CDDP and carboplatinum penetration up to 3 mm from the peritoneal surface [22], and 40 min. of HIPEC increased the depth of DTX penetration 1.46 mm [36,30,42]. Accordingly, HIPEC is considered to be an effective for PM treatment.…”