World Journal of Surgery

, Volume 19, Issue 3, pp 450–454 | Cite as

Prophylaxis with intraoperative chemohyperthermia against peritoneal recurrence of serosal invasion-positive gastric cancer

  • Y. Yonemura
  • I. Ninomiya
  • M. Kaji
  • K. Sugiyama
  • K. Fujimura
  • T. Sawa
  • K. Katayama
  • S. Tanaka
  • Yasuo Hirono
  • K. Miwa
  • I. Miyazaki
Original Scientific Reports

Abstract

Continuous hyperthermic peritoneal perfusion (CHPP) with a solution which contains 30 mg mitomycin C and 300 mg cisplatin has been introduced as a prophylactic treatment for peritoneal recurrence after curative resection of 79 advanced gastric cancers. The control group consisted of 81 patients with advanced gastric cancer who underwent curative surgery during the same period. CHPP was performed for 60 minutes by perfusing MMC- and CDDP-containing saline solutions warmed at 43.5°C by a special CHPP device. In patients with pathologically confirmed serosal invasion-positive tumors, the survival rate of the CHPP group was significantly higher than that of the control group. A survival advantage for stage IV patients was also obtained by CHPP. However, there was no survival advantage between the CHPP group and the control group with serosal invasion-negative tumors. Adverse effects were observed in four patients who underwent CHPP: One developed severe bone marrow suppression, and transient hyperazotemia was ebserved in the other three. There was no difference in the incidence of mortality and morbidity between the two groups. These results indicate that CHPP is a safe, readily available prophylactic therapy for peritoneal recurrence after gastric cancer surgery.

Résumé

La perfusion continue hyperthermique (CHPP) avec une solution contenant 30 mg de mytomycine C (MMC) et 300 mg de cisplatine (CDDP) a été utilisée comme traitement prophylactique pour prévenir la récidive péritonéale chez 79 patients avec un cancer gastrique avancé réséqué. Un groupe composé de 81 patients avec un cancer gastrique avancé qui ont eu une chirurgie à visée curatrice pendant la même période de temps a servi de contrôle. La CHPP, perfusion de MMC et de CDDP mélangés au sérum physiologique réchauffé à 43.5°C par un appareil spécial, était administrée pendant 60 minutes. Lorsque l'envahissement séreux a été confirmé par l'examen anatomopathologique, la survie des patients ayant eu la CHHP était significativement plus longue que lorsque les patients n'avaient pas eu de CHHP. La survie des patients classés stade IV était également améliorée. Il n'y avait aucune amélioration, par contre, de la survie lorsque la couche séreuse n'était pas envahie. Des effets secondaires ont été observés chez quatre patients qui ont une CHHP: un a développé une aplasie médullaire sévère, alors que les trois autres n'ont eu qu'une hyperazotémie transitoire. Il n'y avait, en définitive, aucune différence de mortalité ou de morbidité entre les deux groupes. Ces résultats indiquent que la CHPP est sûre et facilement disponible comme thérapie prophylactique contre la récidive péritonéale après résection de cancer gastrique.

Resumen

La perfusión hipertérmica peritoneal continua (CHPP) con una solución que contiene 30 mg de mitomicina C y 300 mg de cisplatino ha sido introducida como tratamiento profiláctico para prevenir recurrencia peritoneal luego de la resección curativa en 79 pacientes con cáncer gástrico avanzado. El grupo control consistió en 81 pacientes con cáncer gástrico avanzado que fueron sometidos a cirugía curativa en el mismo período de tiempo. La CHPP fue realizada durante 60 minutos con solución salina con MMC y CDDP calentada a 43.5°C por medio de un sistema de CHPP. En los pacientes con invasión serosa confirmada histológicamente, la tasa de sobrevida del grupo CHPP fue significativamente mayor que la del grupo control. También se detectó una ventaja de sobrevida en los pacientes en estado IV tratados con CHPP. Sin embargo, no se encontró ventaja en cuanto a sobrevida entre el grupo CHPP y el grupo control en los pacientes con tumores negativos para invasión serosa. Efectos adversos fueron registrados en 4 pacientes con CHPP:1 desarrolló severa depresión de la médula ósea, e hiperazotemia transitoria fue observada en los otros 3 pacientes. Sin embargo, no se halló diferencia en cuanto a mortalidad y morbilidad entre los dos grupos. Estos resultados indican que la CHPP es una modalidad terapéutica segura y fácilmente disponible para prevenir la recurrencia peritoneal luego de cirugía por cáncer.

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Copyright information

© Société Internationale de Chirurgie 1995

Authors and Affiliations

  • Y. Yonemura
    • 1
  • I. Ninomiya
    • 1
  • M. Kaji
    • 1
  • K. Sugiyama
    • 1
  • K. Fujimura
    • 1
  • T. Sawa
    • 1
  • K. Katayama
    • 1
  • S. Tanaka
    • 1
  • Yasuo Hirono
    • 1
  • K. Miwa
    • 1
  • I. Miyazaki
    • 1
  1. 1.Second Department of Surgery, School of MedicineKanazawa UniversityKanazawa City, IshikawaJapan

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