Prognostic Value of Early Postoperative Intraperitoneal Chemotherapy in Resectable Advanced Gastric Cancer

Yu, Wansik; Chung, Ho Young; Sugarbaker, Paul H

Abstract

PURPOSE: There are variants of gastric cancer associated with predominantly peritoneal spread or with haematogenous metastases. Perioperative intraperitoneal chemotherapy as an adjuvant to surgery is considered as a rational therapeutic modality to prevent peritoneal spread. We evaluated the influence of early postoperative intraperitoneal chemotherapy on the prognosis of resectable advanced gastric cancer. MATENRIALS AND METHODS: From 1990 to 1995, 246 patients with biopsy proven advanced gastric cancer were enrolled in the study. Among them 123 patients received early postoperative intraperitoneal mitomycin C and 5-fluorouracil. The survival rate was calculated using by the Kaplan-Meier method and was compared using the log-rank test according to 13 clinico-pathologic factors. Multivariate analysis was performed with the Cox proportional hazards model.
RESULTS
Gastric resection plus early postoperative intraperitoneal chemotherapy showed an improved survival rate as compared to surgery alone (54.1% versus 40.3%; P= 0.0325). Depth of tumor invasion, degree of regional lymph node metastasis, distant metastasis, tumor size, tumor location, extent of gastric resection, and curability of surgery significantly influenced survival. When a multivariate analysis was performed, depth of tumor invasion, lymph node metastasis, early postoperative intraperitoneal chemotherapy, curability of surgery, and extent of gastric resection emerged as the statistically significant and independent prognostic factors.
CONCLUSION
Early postoperative intraperitoneal chemotherapy is one of the independent prognostic indicators of resectable advanced gastric cancer.