The incidence of early gastric cancer has continued to increase. However, incidence of peritoneal metastasis at the time of first diagnosis still remains at appreximately 10% of the total cases. In these cases, treatment and prognosis are poor.
In
the
this study, athological and clinical characteristics of gastric cancer with periotineal metastasis were analyed. In addition, regimen of cytoreductive surgery against primary and metastatic lesions and intraoperative and early postoperative
intraperitoneal chemotherapy were compared to palliative surgery and systemic chemotherapy.
The study group was comprised fo 40 patients with pathologically confirmed metatatic gastric cancer. Twenty three out of 40 patients had resection of both the primary and meastatic lesions. Remaining 17 patients only had the exploratory
laparotomy
of
gastrojejunostomy with lesions. All patients receiven intraoperative and early postoperative intraperitoneal chemotherapy or systemic chemotherapy.
@ES The results are as follows:
@EN 1) the study group consisted of 40 patients(23 males and 17 females) with a mean age of 48.8 years.
2) In the resection group, 16 patients received total gastrectomy and 7 patients, subtotal gastrectomey. Metastatic lesions were prosent in 18 paritoneum 6 uterus and ovaries, 4 transverse colons, 2 jejunums, 2 acending colons, 1 pancreas, and 1
unilateral ovary.
3) In the resection group, majority of the patients had Berrmann type III and IV primary lesicns (21 cases, 91.3%). Histologicallly, poorly differentiated and signet ring cell carcinoma were most frequent(16 cases, 69.6%)
4) Complications in the resection group included 1 cases of postoperative obstruction, 4 cases of stomatitis, and 8 cases of leukopenia.
5) There were two cases of mortality within 30 days of surgery among the resection group. The cause of death was due to leukopenia, sepsis, and pulmonary embolism.
6) Four deaths occurred among the resection group during the follow up period. These occurred at 5, 7, 8 and 10 months following surgery. These patients had residual tumor.
7) In the non-resection group, the mean survival was 5.2 months (range 1 to 16 months). Although, the follow up period was different between the 2 groups, generally, the outcome of the resected group was better.
In the case of gastriccancer with peritoneal metastasis, complete cytoreductive surgery with adjuvent intraoperative and early post-operative intraperitoneal chemotherpy appears to be relatively safe with better outcome. However, further study is
required before true effective ness of above regimen can be determined.
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