MORBIDITY AND MORTALITY OF EARLY POSTOPERATIVE INTRAPERITONEAL CHEMOTHERAPY AS ADJUVANT THERAPY FOR GASTRIC-CANCER

Intraperitoneal chemotherapy (IC) is emerging as a valuable adjuvant t herapeutic modality in patients with gastric cancer. The purpose of th is study was to assess morbidity and mortality of early postoperative IC (EPIC) in gastric cancer patients. Two hundred forty-eight gastric cancer patients thought to have resectable cancer were randomized intr aoperatively to receive EPIC with mitomycin C on postoperative day 1 a nd 5-fluorouracil on postoperative days 2 to 5 versus surgery only. Si xty-four patients who were stage IV at histopathologic examination rem ain in the analysis. Morbidity and mortality were compared using Fishe r's exact test. All patients completed the therapy. In the study group , overall morbidity was higher than in the control group (28.8% versus 20.3%, respectively), although the difference was not significant (P = 0.121). Intra-abdominal sepsis without anastomotic leak. (P = 0.008) and bleeding (P = 0.002) occurred significantly more often in the stu dy group. Also, 37.6 per cent of patients who received EPIC experience d a variety of minor complications attributable to EPIC. Postoperative mortality was higher in the study group (5.6%) than in controls (0.8% ), but not significantly (P = 0.299). Patients treated with EPIC staye d in the hospital an average of 4 days longer (P = 0.002); in patients with morbidity, however, there was no difference with the control gro up. A period analysis of the morbidity demonstrated that it followed t he pattern of a learning curve. Surgery with EPIC tended to increase t he postoperative morbidity and mortality. The therapy-associated risk must be justified by a significant improvement in survival of treated patients with stage III disease. Selective application of perioperativ e IC mag be indicated.