Clinical Evaluation for the Effect of Intraoperative Intraperitoneal Chemotherapy in Advanced Gastric Cancer

ABSTRACT

BACKGROUND: Peritoneal carcinomatosis is the most common type of treatment failure in gastric cancer patients. For the purpose of decreasing the rate of peritoneal carcinomatosis, intraperitoneal chemotherapy is a very attractive treatment modality, especially in the aspect of direct infusion of the anti-cancer regimen into the peritoneal cavity. METHODS: The effects of intraperitoneal chemotherapy with cisplatin were evaluated using 360 gastric adenocarcinoma patients with serosal invasion who had received a curative gastric resection from June 1992 to June 1996. Among them, 136 cases were treated by installation of cisplatin 100 mg (mixed with 800 ml of normal saline) into the peritoneal cavity before closing the peritoneum, and the solution was drained out 2 hours later. An analysis was performed to determine the differences of survival rate and mode of recurrence between the intraperitoneal cisplatin installation group and the control group (who did not receive the intraperitoneal chemotherapy). RESULTS: The differences between those two groups were not statistically significant. We assume that such results were due to the patients being more advanced in the cisplatin-treated group than in the control group, although the comparison was between identically staged groups. CONCLUSIONS: Intraperitoneal chemotherapy with cisplatin did not show an improved survival rate and did not change the recurrent mode after surgery for serosal invasive gastric cancer. However, well- designed, prospective, randomized study should be performed. Also a prospective randomized study with other kinds of regimens or a more tolerable dose for each regimen will be needed for a correct evaluation of the effect of intraperitoneal chemotherapy.