|
KMID : 0376119940210010017
|
|
Medical Journal of the Red Cross Hospital
1994 Volume.21 No. 1 p.17 ~ p.22
|
|
|
Intraperitoneal Hyperthermo-Chemotherapeutic Perfusion (I.H.C.P) -Analysis of the results of IHCP combined with surgery in T4 gastric cancers-
|
|
|
|
|
Abstract
|
|
|
It is well known that serosal invasion and lymph node involvement are the most consistent indicators of the extent of disease and ultimate prognosis in cancer of the stomach. Recentely long ternm survival has been made by extensive lymph node
dissection
but serosal invasion followed by peritoneal seeding has 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 1990 and 18 were received surgery only in 1989.
The Machine for IHCP was made by closed-circuit system. After resecting the stomach masses, we inserted two tubes in left upper quadrent and Douglas pouch and these were connected to the IHCP machine as soon as closing the skin. Perfusate was 5%
lactated Ringer's solution with10 microgram/ml of Mitomycin-C and it was recirculated for 2 hours continuously. Inlet temperatures were 44.5~45.5℃ and intraperitoneal temperature was maintained above 42℃ at least.
Five of 17 patients given IHCP and 9 of 18 patients IHCP died. Twenty months survival rates was 70.6% in the former compared to 50% in the latter (Wilcoxon test: Z=-2.845, p value=0.0044). Although all of 6 patients with gross peritoneal seeding
died,
the one who had free-floating cancer cells in preoperative peritoneal cytology without gross peritoneal seeding (P1) is still alive in good health. Of the 29 patients without gross peritoneal seeding including 13 in IHCP and 16 in control group,
only 1
(7.7%) in IHCP group and 7 (43.8%) in control group died. 20 month survival rates were 92.3% and 56.3% respectively (Wilcoxon test: Z=-2.6656, P value=0.0077). Of the 9 patients in which the cause of death was confirmed, 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. Platedet and albumin levels decreased and GOT, GPT and Alkaline phosphatage levels increased but
they
were almost returned to normal levels within 2 weeks. The patient's postoperative courses were uneventful except one gastrojejunostomy site leakage and the other one of small localized abscess but there was no IHCP related death. These results
show
that
IHCP combined with surgery is a safe, reliable prophyaxis and/or treatment for the peritoneal metastasis in far-advanced stomach cancers.
|
|
|
KEYWORD
|
|
|
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|
|