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A New Comprehensive Treatment for Peritoneal Metastases Using Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemoperfusion

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Hyperthermic Oncology from Bench to Bedside

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Abstract

A game-changing therapy for peritoneal metastasis (PM), now called “comprehensive treatment” was first established in the late 1990s. The treatment consists of aggressive cytoreductive surgery (CRS) combined with perioperative intraperitoneal/systemic chemotherapy. PM is considered as local disease, and the rationale behind the treatment is to remove macroscopic tumors and eradicate residual micrometastasis using perioperative chemotherapy (POC). Comprehensive treatment consists of laparoscopic evaluation of the tumor load, POC, and CRS. POC includes six procedures including laparoscopic hyperthermic intraperitoneal chemotherapy (LHIPEC), neoadjuvant intraperitoneal/systemic chemotherapy (NIPS), hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC), extensive intraoperative peritoneal lavage (EIPL), early postoperative intraperitoneal chemotherapy (EPIC), and late postoperative systemic chemotherapy. In a study of gastric cancer patients with P0/Cy1 status that employed comprehensive treatment, POC was confirmed to eradicate intraperitoneal micrometastasis. For clinical standardization of HIPEC, the concept of the thermal dose should be introduced. One thermal dose is equivalent to 30-min treatment at 43 °C. In gastric cancer, one thermal dose of HIPEC has been shown to reduce the peritoneal cancer index of 3.5, and changed the peritoneal cytology from positive to negative in 70 % of patients.

In gastric cancer, ovarian cancer, colorectal cancer, mesothelioma and pseudomyxoma peritonei, meta-analyses of randomized controlled studies demonstrated that HIPEC significantly improved survival after CRS.

These results suggest that comprehensive treatment is a breakthrough that improves the prognosis of patients with PM.

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Authors and Affiliations

  1. Regional Cancer Therapies, Peritoneal metastasis center, NPO to support peritoneal surface malignancy treatment, Kishiada Tokushukai Hospital and Kusatsu general Hospital, 510, Fukushima-Cho, Simogyou-Ku, Kyoto City, Kyoto, Japan, Zip:600-8189

    Yutaka Yonemura

  2. Kishiwada Tokushukai Hospital, Kishiwada, Japan

    Yutaka Yonemura, Haruaki Ishibashi & Kazuyoshi Takeshita

  3. Kusatsu general hospital, Kusatsu, Japan

    Yutaka Yonemura & Akiyoshi Mizumoto

  4. Dēpartement de Chirurgie Gēnerale, Centre Hospitalier Lyon-Sud Hospices Civils de Lyon, Universitē Lyon, 69495, Lyon, France

    Oliver Glehen

  5. Center of Gastrointestinal Malignancies, Program in Peritoneal Surface Malignancies, MedStar Washington Hospital Center, Washington, DC, 20010, USA

    Paul H. Sugarbaker

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  1. Yutaka Yonemura
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  2. Akiyoshi Mizumoto
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Correspondence to Yutaka Yonemura .

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Editors and Affiliations

  1. Kokura Lab, Health and Medical Sciences, Kyoto Gakuen University, Kyoto, Kyoto, Japan

    Satoshi Kokura

  2. Department of Inflammation and Immunolog, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan

    Toshikazu Yoshikawa

  3. Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan

    Takeo Ohnishi

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Yonemura, Y., Mizumoto, A., Ishibashi, H., Takeshita, K., Glehen, O., Sugarbaker, P.H. (2016). A New Comprehensive Treatment for Peritoneal Metastases Using Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemoperfusion. In: Kokura, S., Yoshikawa, T., Ohnishi, T. (eds) Hyperthermic Oncology from Bench to Bedside. Springer, Singapore. https://doi.org/10.1007/978-981-10-0719-4_34

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