CYTOREDUCTIVE SURGERY AND SANDWICH THERAPY WITH CHEMOHYPERTHERMIC PERITONEAL PERFUSION AND INTRAAORTIC CHEMOTHERAPY FOR PERITONEAL DISSEMINATION IN GASTRIC-CANCER

Cytoreductive resection (RST), chemohyperthermic peritoneal perfusion (CHPP) and/or intra-aortic chemotherapy (IA-chemo) were performed for peritoneal dissemination in gastric cancer. Ninety-six patients with p eritoneal dissemination were grouped into tubercular (TB), 40; nodular (ND), 31; diffuse (DF) type, 19; and others, 6, respectively, by the gross findings. Sixty-three patients underwent RST. Fifty-nine patient s received CHPP by 10-liter heated saline. Thirty patients underwent i ntra-aortic catheterization for the IA-chemo. The 1-year and 2-year su rvival rate (1-ysr and 2-ysr) of the RST(+) group were 47% and 10% sig nificantly greater than the 9% and 0% of the RST(-) group (p<0.001). T he 1-ysr and 2-ysr of the CHPP(+) group were 37% and 11% significantly greater than the 27% and 0% of the CHPP(-) group (p=0.04). In the TB type the 1-ysr and 2-ysr of the former was 43% and 8% significantly gr eater than the 15% and 0% of the latter (p=0.04). But there was no sig nificant difference in survival time between the CHPP(+) and the CHPP( -) group in the ND type (p=0.22) or in the DF type (p=0.42). The 1-ysr and 2-ysr of the IA-chemo(+) group were 49% and 19% significantly gre ater than the 27% and 2% of the IA-chemo(-) group (p<0.01). In the DF type the 1-ysr and 2-ysr of the former was 50% and 33% significantly g reater than the 8% and 0% of the latter (p=0.02). However, there was n o significant difference in survival time between the IA-chemo(+) and the IA-chemo(-) group in the TB type (p=0.06) or in the ND type (p=0.5 0). Moreover, the effect of the combination therapy of CHPP and IA-che mo (the sandwich therapy, SDW) were examined. The 1-ysr and 2-ysr of t he SDW(+) group were 49% and 22% significantly greater than the 24% an d 0% of the SDW(-) group (p=0.002). The sandwich therapy should be per formed in addition to cytoreductive surgery for improvement of prognos is in the patient with intractable peritoneal dissemination.