Upper abdominal stop-flow perfusion as a neo and adjuvant hypoxic regionalchemotherapy for resectable gastric carcinoma. A prospective randomized clinical trial

BACKGROUND/AIMS: Gastric cancer remains a disease with a poor and dismal pr ognosis even after radical surgical resection. The present study attempts t o clarify whether neo and adjuvant hypoxic upper abdominal chemotherapy can improve the survival of patients with gastric cancer undergoing radical su rgical resection. Patterns of failure after surgery for gastric cancer incl ude peritoneal seeding, resection margin recurrence; and liver metastasis. METHODOLOGY: From October 1995 to February 1999, 58 patients with resectabl e gastric cancer were randomly assigned to three groups. Hypoxic upper abdo minal chemotherapy was carried out using Mitomycin-C, 5-Fluorouracil, Leuco vorin, and Farmorubicin, 10 days before surgery, and 20 days following surg ery, in Group A (n=20) with or without in Group B (n=19) systemic chemother apy; the remaining patients (Group C: n=19) had neither neo nor adjuvant tr eatment. RESULTS: The 4-year survival of Group C patients was 29.2%. Group A patient s (surgery plus hypoxic neo and adjuvant chemotherapy and systemic chemothe rapy) had a 4-year survival of 45.5% versus a 4-year survival of 39.2% of G roup B patients (surgery and hypoxic neo and adjuvant abdominal perfusion). Patients of all stages, histologically confirmed, were included in this st udy. CONCLUSIONS: Patients suffering from gastric carcinoma have demonstrated st atistically improved survival by combining resectional surgery with neo and adjuvant hypoxic upper abdominal perfusion and adjuvant systemic chemother apy.