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.
Highlights
Peritoneal metastases (PM) of Gastric Cancer (GC) have been considered a terminal stage of disease [1]
Patients with synchronous and metachronous PM were 27 and 23, respectively and Clinicopathologic characteristics of GC patients with PM are given in Table 1 male/female primary/recurrence mean age histology differentiated poorly differentiated LN metastasis none positive macroscopic type type 3 type 4
Ascites was detected in 34 patients at 1st laparascopic HIPEC (LHIPEC), and the amount of ascites decreased in 14 patients at the 2nd LHIPEC
Summary
Peritoneal metastases (PM) of Gastric Cancer (GC) have been considered a terminal stage of disease [1]. Bidirectional intraperitoneal and systemic chemotherapy (BIPSC) was developed to reduce the tumor burden and to eradicate peritoneal free cancer cells prior to CRS and HIPEC in GC patients with PM [10]. This treatment was designed to eradicate dissemination from both peritoneum and subperitoneal blood vessels. This group published the results of treatment of 194 synchronous and metachronous GC patients with PM and the median survival rate was reached up to 15.8 months, with 1-, 2-, and 5-year survival rates of 66, 32 and 10.7 %, respectively [11]
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