Department of Abdominal Surgery, Hospital A, C, Camargo, Sao Paulo, Brazil.
World J Surg Oncol. 2012 Sep 19;10:195. doi: 10.1186/1477-7819-10-195.
Gastric cancer relapse occurs in about 30% of the patients treated with gastrectomy and D2-lymphadenectomy, mainly as distant or peritoneal metastases. Hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with an improvement in survival and lower peritoneal recurrence, albeit with increased morbidity. The aim of this study is to report the preliminary results of the association of perioperative chemotherapy, radical surgery and HIPEC in high-risk gastric patients in a single institution.
Treatment protocol was started in 2007 and included patients younger than 65 years old, with good performance status and gastric adenocarcinoma with serosa involvement and lymph node metastases, located in the body or antrum. Patients should receive three preoperative cycles of DCF (Docetaxel 75 mg/m2, Cisplatin 75 mg/m2 and continuous intravenous infusion of 5-Fluorouracil 750 mg/m2 for 5 days), followed by gastric resection with D2-lymphadenectomy, hyperthermic intraperitoneal chemotherapy with Mytomicin C 34 mg/m2 and three more postoperative cycles of DCF.
Ten patients were included between 2007 and 2011. Their median age was 47 years old and six were male. Nine were staged with cT4 cN + tumors and one as cT3 cN+. Nine patients completed all three preoperative chemotherapy cycles. Eight individuals were treated with a total gastrectomy and the other two had a distal gastrectomy, all having HIPEC. Postoperative morbidity was 50%, with no deaths. Regarding postoperative chemotherapy, only 5 patients completed three cycles. With a median follow-up of 25 months, three relapses were identified and 7 patients remain disease-free, two with more than 4 years of follow-up.
The association of perioperative systemic and intraperitoneal chemotherapy plus radical surgery is a feasible multimodality treatment, with acceptable morbidity. With a longer follow-up and a larger group of patients, we hope to be able to determine if it also influences survival outcomes and patterns of recurrence.
MINI-ABSTRACT: The association of perioperative chemotherapy, gastric resection and D2-lymphadenectomy and hyperthermic intraperitoneal chemotherapy proved to be associated with acceptable morbidity. For survival analysis, a longer follow-up is needed.
接受胃切除术和 D2 淋巴结清扫术的患者中约有 30%会出现胃癌复发，主要表现为远处或腹膜转移。尽管发病率增加，但腹腔内热化疗（HIPEC）与生存时间的延长和较低的腹膜复发率有关。本研究的目的是报告在一家机构中，将围手术期化疗、根治性手术和 HIPEC 联合应用于高危胃患者的初步结果。
该治疗方案于 2007 年开始实施，纳入标准为年龄<65 岁、一般状况良好、胃腺癌伴浆膜浸润和淋巴结转移、肿瘤位于胃体或胃窦。患者应接受术前 3 个周期的 DCF（多西他赛 75mg/m2，顺铂 75mg/m2，5-氟尿嘧啶持续静脉滴注 750mg/m2，持续 5 天），随后进行胃切除术和 D2 淋巴结清扫术，Mytomicin C 34mg/m2 的 HIPEC，以及术后 3 个周期的 DCF。
2007 年至 2011 年间共纳入 10 例患者。患者的中位年龄为 47 岁，其中 6 例为男性。9 例分期为 cT4 cN+肿瘤，1 例为 cT3 cN+。9 例患者均完成了所有 3 个术前化疗周期。8 例患者接受全胃切除术，另外 2 例接受远端胃切除术，均接受 HIPEC。术后并发症发生率为 50%，无死亡病例。术后化疗方面，仅 5 例患者完成了 3 个周期。中位随访 25 个月时，发现 3 例复发，7 例无病生存，其中 2 例随访时间超过 4 年。
围手术期全身和腹腔内化疗联合根治性手术是一种可行的多模式治疗方法，具有可接受的发病率。随着随访时间的延长和患者数量的增加，我们希望能够确定它是否也会影响生存结果和复发模式。
