HIPEC in treatment of gastric cancer with high risk of carcinomatosis: Russians Regional Centre experience.

Abstract

e15501 Background: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a treatment method in patients with gastric cancer having a high risk of development of peritoneal carcinomatosis which can improve treatment results. Methods: HIPEC in a "prophylactic" setting in gastric patients having a high risk of peritoneal carcinomatosis development has been applied in our centre since 2015. This method was used in cases of diffuse type poor-differentiated tumor histology , massive tumor invasion of the stomach serosa and relatively young age of the patient. A “closed” HIPEC technique, with 3 inflow and 3 outflow catheters, RAND HT performer and 7 liters of saline solution with 200 mg cisplatinum was performed. Up to this moment we have treated 8 patients with gastric surgery added by HIPEC. There were 4 men and 4 women. Median age was 48 years. In 2 cases distal subtotal gastric resection was performed, in other 6 cases - total gastrectomy with a D2 lymph nodes dissection. In 2 cases was also performed an edge resection of the pancreas. 2 procedures were performed in cases with ovarian metastases and local diaphragm canceromatosis, with complete cytoreduction. Median surgery time was 4 hours. Results: There was no mortality in early postoperative period, with 25% morbidity. In one case a severe postoperative pancreonecrosis occured which required several re-operations. In one case there has been an acute renal failure, after 3 dialyse sessions the renal function was recovered. Median post-operative hospital stay was 20 days. Two patients are alive without progression on 14 and 23 months respectively. One patient developed a local anastomotic recurrence, no other progression was found, and anastomosis extirpation was performed. Patients having ovarian metastases and local canceromatosis progressed in 6 months, in other cases progression was found in 6 to 12 months. Conclusions: The use of HIPEC doesn't result in elevation of complications or mortality rate. It shows a trend to improve the results of treatment gastric cancer. In cases of already existing canceromatosis the effectiveness of HIPEC is doubtful.