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KMID : 0371319930450010097
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Journal of the Korean Surgical Society
1993 Volume.45 No. 1 p.97 ~ p.102
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Intraperitioneal Hyperthermo-Chemotherapeutic Perfusion(I.H.C>P) -Analysis of the results of IHCP combined with surgery in T4 gastric cancers
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김진영
박현규/우충아/이윤헌/이상희/박은섭/박승균/송광재
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Abstract
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It is well known that serosal invasion and lymph node involvement are the most consistent indicatrors of the extent of disease and ultimate prognosis in stomach cancer. Recentely long term survival has been made by extensive lymph node dissection
but
serosal invasion followed by peritoneal seeding has been remained as problem. Since Spratt et al reported intraperitoneal hyperthermic chemotherapy was performed after excision of intraabdominal tumors in 1980, it has been developed rapidly in
Japan.
We investigated with the 35 far-advanced gastric cancer patients(above T4). 17 patients were treated by IHCP combined with surgery from January 1990 and 18 patients of control group underwent surgical treatment only from January 1988 to December
1989.
The Machine for IHCP was made by closed-circuit system. After resecting the stomach masses, we inserted two tubes I left upper quarent and Douglas pouch and these were connected to the IHCP machine as soon as closing the skin. Perfusate was 5%
lactated
Ringer's Solution with 10 microgram/ml of Mitomycin-C and it was recurculated for 2 hours continuousely. Inlet temperatures were 44.5~45.5℃and intraperitoneal temperature was maintained above 42℃ at least.
5 of 17 patients given IHCP and 9 of 18 patients not given IHCP died. 2 year survival rates was 70.6% in the former compared to 50% in the latter(Wilcoxon test: Z=-2.8451, P value 0.0044). Although all of 6 patients with gross peritoneal seeding
died,
but the one with freefloating cancer cells in preoperative peritoneal cytology without gross peritoneal seeding(P1) is still alive in a good health. Of the 29 patients without gross peritoneal seeding included 13 in IHCP and 16 in control group,
only
one(7.7%) in IHCP group but 7(43.8%) in control group died. 2 year survival rates were 92.3% and 56.3% respectively(Wilcoxon test: Z=-2.6656, P value=0.0077). Of the 9 patients conformed the cause of death. Only 1 (25%) out of 4 patients in IHCP
group
was died of progression of previous peritoneal seeding, while 4(80%) out of 5 patients in control group were died of peritoneal seeding. Platelet and albumin levels decreased and GOT, GPT and Alkaline phosphatase levels increased but they were
almost
returned to normal levels within 2 weeks. The patients' postoperative courses were uneventful except one gastrojejunostomy site leakage and the other one of small localized abscess but there was no IHCP related death. There results show that IHCP
combined with surgery is a safe, reliable prophylaxis and/or treatment for the peritoneal metastasis in far-advanced stomach cancers.
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KEYWORD
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