Annals of Surgical Oncology

, Volume 21, Issue 4, pp 1147–1152 | Cite as

Outcome Data of Patients with Peritoneal Carcinomatosis from Gastric Origin Treated by a Strategy of Bidirectional Chemotherapy Prior to Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in a Single Specialized Center in Japan

  • Emel Canbay
  • Akiyoshi Mizumoto
  • Masumi Ichinose
  • Haruaki Ishibashi
  • Shouzou Sako
  • Masamitsu Hirano
  • Nobuyuki Takao
  • Yutaka Yonemura
Gastrointestinal Oncology



Management of peritoneal disseminated gastric cancer (GC) remains a challenging problem. The purpose of our study was to evaluate the outcome of bidirectional induction chemotherapy [bidirectional intraperitoneal and systemic induction chemotherapy (BIPSC)] in patients with peritoneal carcinomatosis (PC) arising from GC who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Patients and Methods

Overall, 194 patients with PC arising from GC were treated with BIPSC comprising intraperitoneal docetaxel at a dose of 20 mg/m2 and cisplatin at a dose of 30 mg/m2 followed by four cycles of oral S-1 at a dose of 60 mg/m2. CRS and HIPEC were performed in responders to BIPSC.


Of these 194 patients, 152 (78.3 %) underwent CRS and HIPEC between January 2005 and December 2012. Treatment-related mortality was 3.9 %, and major complications occurred in 23.6 % of patients. The median survival rate was 15.8 months, with 1-, 2-, and 5-year survival rates of 66, 32 and 10.7 %, respectively, in the patients treated with combined treatment. Multivariate analysis identified pathologic response to BIPSC (p = 0.001), low tumor burden [peritoneal cancer index (PCI) ≤ 6] (p = 0.001), and completeness of CRS (CC-0, CC-1) (p = 0.001) as independent predictors for a better prognosis.


As a viable option, BIPSC with CRS and HIPEC for patients with PC arising from GC may be performed safely, with acceptable morbidity and mortality, in a specialized unit. Response to BIPSC, optimal CRS and limited peritoneal dissemination seem to be essential to achieve the best outcomes in these patients.


Gastric Cancer CDDP Peritoneal Carcinomatosis Peritoneal Cancer Index Hyperthermic Intraperitoneal Chemotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynaecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88:358–63.PubMedCrossRefGoogle Scholar
  2. 2.
    Bozzetti F, Yu W, Baratti D, Kusamura S, Deraco M. Locoregional treatment of peritoneal carcinomatosis from gastric cancer. J Surg Oncol. 2008;98:273–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Glimelius B, Ekstrom K, Hoffman K, et al. Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol. 1997;8:163–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol. 2006; 24:2903–3909.PubMedCrossRefGoogle Scholar
  5. 5.
    Yonemura Y, Kawamura T, Bandou E, Takahashi S, Sawa T, Matsuki N. Treatment of peritoneal dissemination from gastric cancer by peritonectomy and hemohyperthermic peritoneal perfusion. Br J Surg. 2005;92:370–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Glehen O, Schreiber V, Cotte E, et al. Cytoreductive surgery and intraperitoneal chemohyperthermia for peritoneal carcinomatosis arising from gastric cancer. Arch Surg. 2004; 139:20–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Hall JJ, Loggie BW, Shen P, et al. Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for advanced gastric cancer. J Gastrointest Surg. 2004; 8:454–463.PubMedCrossRefGoogle Scholar
  8. 8.
    Yonemura Y, Bandou E, Sawa T, et al. Neoadjuvant treatment of gastric cancer with peritoneal dissemination. Eur J Surg Oncol. 2006;32:661–65.PubMedCrossRefGoogle Scholar
  9. 9.
    Yonemura Y, Endou Y, Shinbo M, et al. Safety and efficacy of bidirectional chemotherapy for treatment of patients with peritoneal dissemination from gastric cancer: selection for cytoreductive surgery. J Surg Oncol. 2009;100:311–16.PubMedCrossRefGoogle Scholar
  10. 10.
    Yonemura Y, Elnemr A, Endou Y, Ishibashi H, Mizumoto A, Miura M, et al. Effects of neoadjuvant intraperitoneal/systemic chemotherapy (bidirectional chemotherapy) for the treatment of patients with peritoneal metastasis from gastric cancer. Int J Surg Oncol. 2012;2012:148420.PubMedCentralPubMedGoogle Scholar
  11. 11.
    Okabe H, Ueda S, Obama K, Hosogi H, Sakai Y. Induction chemotherapy with S-1 plus cisplatin followed by surgery for treatment of gastric cancer with peritoneal dissemination. Ann Surg Oncol. 2009;16:3227–36.PubMedCrossRefGoogle Scholar
  12. 12.
    Fujiwara Y, Takiguchi S, Nakajima K, et al. Neoadjuvant intraperitoneal and systemic chemotherapy for gastric cancer patients with peritoneal dissemination. Ann Surg Oncol. 2011;18:3726–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Imano M, Yasuda A, Itoh T, et al. Phase II study of single intraperitoneal chemotherapy followed by systemic chemotherapy for gastric cancer with peritoneal metastasis. J Gastrointest Surg. 2012;16:2190–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Sugarbaker PH. Peritonectomy procedures. Cancer Treat Res. 1996;82:235–53.PubMedCrossRefGoogle Scholar
  15. 15.
    White SK, Stephens AD, Sugarbaker PH. Hyperthermic intraoperative intraperitoneal chemotherapy safety considerations. AORN J. 1996;63:716–24.PubMedCrossRefGoogle Scholar
  16. 16.
    Jacquet P, Sugarbaker PH. Current methodologies for clinical assessment of patients with peritoneal carcinomatosis. J Exp Clin Cancer Res. 1996;15:49–68.Google Scholar
  17. 17.
    Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst. 2009;92:205–16.CrossRefGoogle Scholar
  18. 18.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–112.CrossRefGoogle Scholar
  19. 19.
    Badgwell B, Cornier JN, Krishnan S, et al. Does neoadjuvant treatment for gastric cancer patients with positive peritoneal cytology at staging laparoscopy improve survival? Ann Surg Oncol. 2008;15:2684–91.PubMedCrossRefGoogle Scholar
  20. 20.
    Lorenzen S, Panzram B, Rosenberg R, et al. Prognostic significance of free peritoneal tumor cells in the peritoneal cavity before and after neoadjuvant chemotherapy in patients with gastric carcinoma undergoing potentially curative resection. Ann Surg Oncol. 2010;17:2733–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Fujimoto S, Takahashi M, Mutou T, et al. Improved mortality rate of gastric carcinoma patients with peritoneal carcinomatosis treated with intraperitonel hyperthermic chemoperfusion combined with surgery. Cancer. 1997;79:884–91.PubMedCrossRefGoogle Scholar
  22. 22.
    Glehen O, Schreiber V, Cotte E, et al. Cytoreductive surgery and intraperitoneal chemohyperthermia for peritoneal carcinomatosis arising from gastric cancer. Arch Surg. 2004;139:20–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Ishigami H, Kitayama J, Kaisaki S, et al. Phase II study of weekly intravenous and intraperitoneal paclitaxel combined with S-1 for advanced gastric cancer withperitoneal metastasis. Ann Oncol. 2010;21:67–70.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Emel Canbay
    • 1
  • Akiyoshi Mizumoto
    • 2
  • Masumi Ichinose
    • 2
  • Haruaki Ishibashi
    • 2
  • Shouzou Sako
    • 1
  • Masamitsu Hirano
    • 2
  • Nobuyuki Takao
    • 2
  • Yutaka Yonemura
    • 1
    • 2
    • 3
  1. 1.NPO to Support Peritoneal Dissemination Treatment, Department of General SurgeryTokushu-Kai HospitalKishiwadaJapan
  2. 2.Department of General SurgeryKusatsu General HospitalKusatsuJapan
  3. 3.Department of General SurgeryKishiwada Tokushukai HospitalKishiwadaJapan

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