The Clinical Experiences of Continuous Hyperthermic Peritoneal Perfusion on Advanced Gastric Cancer

Kwon, Sung Joon; Kim, Dong Woo

Abstract

One of the major problems after surgery for gastric cancer that invades the gastric serosa is peritoneal metastasis. Despite recent advances in anti-cancer chemotherapy, no satistactory treatment has been established for peritoneal metastasis. In the 1980s, hyperthermia therapy was introduced, because hyperthermia has a direct anti-cancer and synergistic effect with some kinds of anticancer drugs. We investigated 101 advanced gastric cancer patients who exhibited serosal invasion in gross. Twenty three patients were treated by continuous hyperthermic peritoneal perfusion(CHPP) combined with surgery from Feb. 1993 to Nov. 1994, and 78 patients in the control group underwent surgical treatment only at the same period. The results are as follows; 1) The ratio of peritoneal seeding was higher in the CHPP group(P<0.005). 2) The ratio of metastatic lymph nodes to total dissected lymph nodes above 30% was higher in CHPP group(P=0.02). 3) In comparison of the gross type, CHPP group showed higher incidence of Borrmann type IV (P<0.005). 4) In comparison of the type of operation, CHPP group underwent a higher ratio of total gastrectomy (P<0.005). 5) Cancer cells in the preoperative peritoneal irrigation fluid were positive in 6 cases but these floating cancer cells disappeared after CHPP in all cases. 6) The postoperative courses of CHPP group were the same as those of the control group. 7) There was no case of perioperative or postoperative mortality. 8) The cases of peritoneal metastasis in CHPP group showed a significantly higher survival ratio than in the control group (P=0.02). These results show that CHPP using chemotherapeutic agent combined with surgery is a relatively safe and reliable treatment or prophylactic method of peritoneal metastasis in advanced gastric cancer with peritoneal seeding or with serosal invasion.