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/m2). 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 1st and 2nd 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 1st session, and the positive cytology changed to be negative in 16 (57.1%) of 28 patients at the second session. PCI at the 2nd session (12.5 ± 10.5) was significantly lower than that at the 1st session (16.8 ± 9.6) (P=0.023). PCI levels at the 2nd 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.