Management of Peritoneal Metastases Developed from Gastric Cancer: Laparascopic Hyperthermic Intraperitoneal Chemontherapy in Neoadjuvant Setting

Abstract

Objective: Peritoneal Metastases (PM) of Gastric Cancer (GC) are lesions of peritoneal surfaces, which may cause the dissemination throughout the abdominal cavity. The role of laparoscopic Hyperthermic Intraperitoneal Chemotherapy (HIPEC) as neoadjuvant purpose in the management of PM of GC is undefined. Methods: Fifty patients were enrolled into this study with histopathological diagnosis of PM of GC referred to our center between 2012 and 2013 All patients were underwent two cycles of neoadjuvant laparoscopic HIPEC. At the second session of LHIPEC, ascites volume, cytological status and PCI levels were compared with those at the 1st LHIPEC. Results: There was no intraoperative complication and mortality after LHIPEC. Four patients developed mild azotemia of Grade 2. Amount of ascites were completely abolished or decreased in 22 of 34 (64.7%) and positive peritoneal cytology changed to be a negative in 14 of 20 (70%) patients at the 2nd LHIPEC. Complete response was in 6 (12%), and peritoneal cancer indices (PCI) were significantly reduced from 14.3 ± 10.2 at the 1st LHIPEC to 10.8 ± 10.5 at the 2nd LHIPEC (p<0.05). Furthermore, total PCI scores on small bowel mesentery at 1st and 2nd LHIPEC were 6.56 ± 2.92 and 5.25 ± 3.78 (P=0.016). Conclusions: This study identified two outcomes. Diagnostic and therapeutic laparoscopy can be performed safely in patients with PM of GC. Laparoscopic HIPEC can be applied as a neoadjuvant treatment modality in order to reduce the tumor burden and disease control until complete managements to be achieved in patients with PM of GC.