Department of Surgical Oncology, University of Tokyo, Tokyo, Japan,
Ann Surg Oncol. 2014 Feb;21(2):539-46. doi: 10.1245/s10434-013-3208-y. Epub 2013 Aug 22.
Peritoneal metastasis of gastric cancer has extremely poor clinical outcomes. Recently, we developed a combination chemotherapy that used intraperitoneal (IP) paclitaxel (PTX) and produced excellent antitumor effects against peritoneal lesions. However, no information is available about the benefit of gastrectomy in cases with malignant ascites.
A total of 64 patients with severe peritoneal metastasis and ascites received IP PTX at 20 mg/m(2) via implanted subcutaneous peritoneal access ports as well as intravenous (IV) PTX at 50 mg/m(2) on days 1 and 8. S-1 was administered at 80 mg/m(2) day for 14 consecutive days, followed by 7 days of rest. In all patients, investigative laparoscopy was performed around the combination chemotherapy, and gastrectomy was performed on patients who showed apparent shrinkage of their peritoneal nodules as well as negative peritoneal cytology at the second laparoscopy.
Gastrectomy was performed in 34 patients. The median course of chemotherapy before surgery was 5 courses (range 2-16). R0 operation was achieved in 22 patients (65%), and grade 2 and 3 histological responses were obtained in 7 (21%) and 1 (3%) patient(s), respectively. The median survival time and 1-year overall survival of the gastrectomized patients were 26.4 months and 82%, and those of the 30 patients who did not receive gastrectomy were 12.1 months and 26%, respectively. Morbidity was minimal, and there was no mortality.
Salvage gastrectomy after chemotherapy of S-1 with IV and IP PTX is promising, even for patients with highly advanced gastric cancer and severe peritoneal metastasis and malignant ascites.
胃癌腹膜转移的临床预后极差。近期，我们研发了一种联合化疗方案，采用腹腔内（IP）紫杉醇（PTX），对腹膜病变具有出色的抗肿瘤作用。然而，对于合并恶性腹水的患者，胃切除术是否有益尚不清楚。
共 64 例严重腹膜转移伴腹水患者接受 IP 紫杉醇 20mg/m² 经皮下植入式腹膜接入端口给药，同时在第 1 天和第 8 天静脉（IV）紫杉醇 50mg/m² 给药。S-1 以 80mg/m² 的剂量持续 14 天给药，然后休息 7 天。所有患者均在联合化疗前后进行腹腔镜探查，如果第二次腹腔镜检查显示腹膜结节明显缩小且腹膜细胞学检查为阴性，则进行胃切除术。
34 例患者进行了胃切除术。手术前化疗的中位疗程为 5 个疗程（范围 2-16）。22 例患者（65%）实现了 RO 手术，7 例（21%）和 1 例（3%）患者获得了组织学分级 2 级和 3 级反应。行胃切除术患者的中位生存时间和 1 年总生存率分别为 26.4 个月和 82%，未行胃切除术患者的中位生存时间和 1 年总生存率分别为 12.1 个月和 26%。并发症发生率低，无死亡病例。
即使对于晚期胃癌合并严重腹膜转移和恶性腹水的患者，S-1 联合 IV 和 IP PTX 化疗后的挽救性胃切除术也是有希望的。
