Final Results of Surgery Plus Intraperitoneal Hyperthermo-Chemo-Perfusion (IHCP) for the Prevention and the Treatment of Peritoneal Recurrence in Advanced Gastric Carcinomas

ABSTRACT

PURPOSE: Despite recent advances in the treatment for serosa invasive gastric carcinomas, no satisfactory outcomes are available because of early peritoneal recurrence caused by micrometastases and free floating cancer cells already existing in the peritoneal cavity. METHODS: We analyzed 103 serosa invasive gastric carcinoma patients who had recieved a surgical resection with or without IHCP from 1990 to 1995. All the patients were pathologically staged according to the UICC classification (1997) Stage II in 17 patients, IIIA in 24, IIIB in 24 and IV in 38. Under hypothermic general anesthesia (32.4- 34oC), IHCP was performed for 2 hours using 1.5% peritoneal dialysis solution mixed with l0 microgram/ml of mitomycin-C warmed at an inflow temperature over 43.5oC in 52 patients. RESULTS: 69 patients died during follow up period. The overall 5-YSR (year survival rate) was 32.8% in the IHCP group, 27.1% in the control group but this difference was not statistically significant. However, in 65 patients, except for those in stage IV, the 5-YSR was 58.6% in the IHCP group and 44.4% in the control group, this difference was statistically significant (p=0.0379). Especially in stage IIIB, the 5-YSR was significantly higher in the IHCP group than in the control group, 41.7% and 25% respectively (p=0.0417). The median survival in the IHCP group (36 mon.) was longer than the control group (22.9 mon.) due to differences in the recurrence patterns. The most common recurrence pattern in the control group was early peritoneal recurrence, but it was late local recurrence in the IHCP group. The types and the rates of complications between the two groups were not different, except for 3 patients with pancytopenia and renal insufficiency in the IHCP group. CONCLUSION: Complete cytoreductive surgery plus IHCP was a safe and effective method to prevent peritoneal recurrence and should lead to long term survival in serosa invasive gastric carcinoma patients, except for those in stage IV with distant metastases.