J Gastric Cancer.  2014 Dec;14(4):266-270. 10.5230/jgc.2014.14.4.266.

The Result of Conversion Surgery in Gastric Cancer Patients with Peritoneal Seeding

• Kim SW

• KMID: 2183651
• DOI: http://doi.org/10.5230/jgc.2014.14.4.266

Abstract

PURPOSE
Palliative gastrectomy and chemotherapy are important options for peritoneal seeding of gastric cancer. The treatment stage IV gastric cancer patient who respond to induction chemotherapy, is converted to gastrectomy (conversion therapy or conversion surgery). This study explored the clinical outcomes of gastric cancer patients with peritoneal seeding who had undergone conversion therapy.
MATERIALS AND METHODS
Between 2003 and 2012, gastric cancer patients with peritoneal seeding, as determined by preoperative or intraoperative diagnosis were reviewed retrospectively. Clinicopathologic characteristics and clinical outcomes of patients with peritoneal seeding were analyzed.
RESULTS
Forty-three patients were enrolled. Eighteen patients had undergone conversion surgery and 25 patients continued conventional chemotherapy. Among the 18 conversion patients, 10 received clinically curative resection. The median follow-up period was 28.5 months (range 8 to 60 months) and the total 3-year survival rate was 16.3%. The median survival time of the patients who received clinically curative conversion therapy was 37 months, and the 3-year survival rate was 50%. The median follow-up for non-curative gastrectomy patients was 18 months. No patient treated using chemotherapy survived to 3 years; the median survival time was 8 months. The differences in survival time between the groups was statistically significant (P<0.001).
CONCLUSIONS
In terms of survival benefits for gastric cancer patients with peritoneal seeding, clinically curative conversion therapy resulted in better clinical outcomes.

Keyword

Stomach neoplasms; Carcinomatosis; Chemotherapy; Gastrectomy

MeSH Terms

Carcinoma
Diagnosis
Drug Therapy
Follow-Up Studies
Gastrectomy
Humans
Induction Chemotherapy
Retrospective Studies
Stomach Neoplasms*
Survival Rate

Figure

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  Fig. 1 Survival curves for gastric cancer patients with peritoneal seeding according to the treatment received.

Reference

1. Gunderson LL, Sosin H. Adenocarcinoma of the stomach: areas of failure in a re-operation series (second or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int J Radiat Oncol Biol Phys. 1982; 8:1–11.

2. Landry J, Tepper JE, Wood WC, Moulton EO, Koerner F, Sullinger J. Patterns of failure following curative resection of gastric carcinoma. Int J Radiat Oncol Biol Phys. 1990; 19:1357–1362.

3. Wisbeck WM, Becher EM, Russell AH. Adenocarcinoma of the stomach: autopsy observations with therapeutic implications for the radiation oncologist. Radiother Oncol. 1986; 7:13–18.

4. Yonemura Y, Fujimura T, Fushida S, Takegawa S, Kamata T, Katayama K, et al. Hyperthermo-chemotherapy combined with cytoreductive surgery for the treatment of gastric cancer with peritoneal dissemination. World J Surg. 1991; 15:530–535.

5. Ryu KW, Mok YJ, Kim SJ, Kim CS. Prognostic factors in advanced gastric cancer with peritoneal carcinomatosis. J Korean Surg Soc. 2000; 59:786–792.

6. Funaki H, Fujita J, Morioka E, Kaida D, Ohnishi T, Ohno Y, et al. Evaluation of conversion gastrectomy for treatment of Stage IV advanced gastric cancer. Gan To Kagaku Ryoho. 2013; 40:1615–1617.

7. Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma: 2nd English edition. Gastric Cancer. 1998; 1:10–24.

8. Japanese Gastric. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–123.

9. Sugarbaker PH, Yonemura Y. Clinical pathway for the management of resectable gastric cancer with peritoneal seeding: best palliation with a ray of hope for cure. Oncology. 2000; 58:96–107.

10. Ikeguchi M, Oka A, Tsujitani S, Maeta M, Kaibara N. Relationship between area of serosal invasion and intraperitoneal free cancer cells in patients with gastric cancer. Anticancer Res. 1994; 14:2131–2134.

11. Sugarbaker PH. Peritonectomy procedures. Surg Oncol Clin N Am. 2003; 12:703–727.

12. Kuramoto M, Shimada S, Ikeshima S, Matsuo A, Yagi Y, Matsuda M, et al. Extensive intraoperative peritoneal lavage as a standard prophylactic strategy for peritoneal recurrence in patients with gastric carcinoma. Ann Surg. 2009; 250:242–246.

13. Stern JL, Denman S, Elias EG, Didolkar M, Holyoke ED. Evaluation of palliative resection in advanced carcinoma of the stomach. Surgery. 1975; 77:291–298.

14. Kim HI, Ha TK, Kwon SJ. Prognostic factors in gastric cancer patients with peritoneal carcinomatosis. J Gastric Cancer. 2010; 10:126–132.

15. Hünerbein M, Rau B, Hohenberger P, Schlag PM. The role of staging laparoscopy for multimodal therapy of gastrointestinal cancer. Surg Endosc. 1998; 12:921–925.

16. Song SC, Lee SL, Cho YK, Han SU. The role and efficacy of diagnostic laparoscopy to detect the peritoneal recurrence of gastric cancer. J Korean Gastric Cancer Assoc. 2009; 9:51–56.

17. Yonemura Y, Bandou E, Sawa T, Yoshimitsu Y, Endou Y, Sasaki T, et al. Neoadjuvant treatment of gastric cancer with peritoneal dissemination. Eur J Surg Oncol. 2006; 32:661–665.

18. Glehen O, Gilly FN, Arvieux C, Cotte E, Boutitie F, Mansvelt B, et al. Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2010; 17:2370–2377.

19. Badgwell B, Cormier JN, Krishnan S, Yao J, Staerkel GA, Lupo PJ, et al. Does neoadjuvant treatment for gastric cancer patients with positive peritoneal cytology at staging laparoscopy improve survival? Ann Surg Oncol. 2008; 15:2684–2691.

20. Seo YJ, Bae JM, Kim SW, Kim SW, Song SK. Different clinical outcomes of stage iv gastric cancer according to the curability of surgery. J Korean Surg Soc. 2009; 77:170–176.

21. Hioki M, Gotohda N, Konishi M, Nakagohri T, Takahashi S, Kinoshita T. Predictive factors improving survival after gastrectomy in gastric cancer patients with peritoneal carcinomatosis. World J Surg. 2010; 34:555–562.

22. Pollock RE, Roth JA. Cancer-induced immunosuppression: implications for therapy? Semin Surg Oncol. 1989; 5:414–419.

23. Yoon SY, Kim MG, Oh ST. The impact of preoperative chemotherapy on the surgical management of unresectable gastric cancer. J Korean Gastric Cancer Assoc. 2009; 9:269–274.