J Cancer Cure | Volume 1, Issue 1 | Research Article | Open Access
Yutaka Yonemura1*, Emel Canbay1, Haruaki Ishibashi1, Masamitu Hirano1, Akiyoshi1, Mizumoto1, Nobuyuki Takao1, Masumi Ichinose1, Kousuke Noguchi1, Yang Liu1, Satoshi Wakama1, Shinya Shimada2, Federico Coccolini3, Keizou Taniguchi4 and Sachio Fushida5
1Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital and Kusatsu General Hospital, Oosaka, Shiga, Japan
2Department of General Surgery Department, Kumamoto General Hospital, Yatushiro, Japan
3Department of General Surgery, Ospedola, Maggiore, Parma, Italy
4Department of Surgery, Teikyou University Hospital, Yokohama, Japan
5Department of Gastroenterological Surgery, Kanazawa University, Kanazawa, Japan
*Correspondance to: Yutaka Yonemura
Fulltext PDFBackground: Peritoneal metastasis (PM) from gastric cancer (GC) was once considered a lethal disease. After the late 1990s, the therapeutic goal changed from palliative to curative intent because of a development a comprehensive treatment combining cytoreductive surgery (CRS) and perioperative chemotherapy.
Methods: Recent advances in the treatment of PM from GC reported in 18 studies including 2327 patients were reviewed.
Results: In patients with PM, systemic chemotherapy alone had a limited and non-curative effect. In contrast, radical gastrectomy plus neoadjuvant intraperitoneal/systemic chemotherapy (NIPS), early postoperative intraperitoneal chemotherapy (EPIC), or postoperative S1 treatment was shown to improve the survival of patients with cytology-positive (Cy1) peritoneal lavage fluid without macroscopic PM (P0) (P0Cy1). After 5 years, 23 among 154 patients were disease free. For the treatment of patients with macroscopic PM (P1), exploratory laparotomy to determine the peritoneal cancer index (PCI) and neoadjuvant laparoscopic hyperthermic intraperitoneal perfusion (LHIPEC) were performed. The combination of NIPS and LHIPEC was effective in patients with P1, but NIPS or LHIPEC alone were ineffective and all patients receiving one or the other died. In contrast, the 5-year survival rate after cytoreductive surgery (CRS) +HIPEC ranged from 6% to 13%, and 18 among 284 patients were disease free at 5 years.
Conclusion: Although CRS and NIPS have an important role in treatment of PM from GC, complete cytoreduction by gastrectomy and peritonectomy after NIPS combined with intraoperative HIPEC, EPIC, and late postoperative chemotherapy may cure the patients with P0Cy1 or P1 disease.
Yonemura Y, Canbay E, Ishibashi H, Hirano M, Akiyoshi, Mizumoto, et al.Recent Advances in the Treatment of Peritoneal Metastasis from Gastric Cancer. J Cancer Cure. 2018;1(1):1003.