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Effects of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy and Neoadjuvant Intraperitoneal/Systemic Chemotherapy on Peritoneal Metastases from Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The Peritoneal Cancer Index (PCI) is the most important prognostic factor following comprehensive treatment for peritoneal metastasis (PM) from gastric cancer (GCPM); however, 70 % of patients with GCPM showed a PCI score above the cut-off level at the time of diagnosis. Furthermore, neoadjuvant chemotherapy may reduce the PCI score to lower than the cut-off levels. In this study, the effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion (NLHIPEC) and neoadjuvant intraperitoneal/systemic chemotherapy (NIPS) were investigated.

Materials and Methods

In group A, NLHIPEC was performed twice in 53 patients with GCPM, separated by a 1-month rest interval. Changes in the PCI were studied at the time of first and second laparoscopy. In group B, after NLHIPEC, a series of 3-week cycles of NIPS were performed over three courses in 52 patients. A laparotomy for cytoreductive surgery (CRS) was then carried out and the PCI changes were studied.

Results

In group A, the PCI score at the time of the second session (11.8 ± 11.0) was significantly lower than at the time of the first session (14.2 ± 10.7), while in group B, the PCI at the time of laparotomy (9.9 ± 11.3) was significantly lower than at the time of NLHIPEC (14.8 ± 11.4). After NLHIPEC plus NIPS, complete cytoreduction was achieved in 30 (57.6 %) patients.

Conclusions

NLHIPEC and NIPS are effective methods of reducing PCI levels before CRS.

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Conflicts of Interest

Yutaka Yonemura, Haruaki Ishibashi, Masamitu Hirano, Akiyoshi Mizumoto, Kazuyosi Takeshita, Kousuke Noguchi, Nobuyuki Takao, Masumi Ichinose, Yang Liu, and Yan Li declare that there were no potential conflicts of interest.

Author information

Authors and Affiliations

  1. NPO Organization to Support Peritoneal Surface Malignancy Treatment, Osaka, Shiga, Japan

    Yutaka Yonemura PhD & Yang Liu MD

  2. Department of Regional Cancer Therapies, Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kusatsu General Hospital, Kishiwada, Japan

    Yutaka Yonemura PhD

  3. Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan

    Yutaka Yonemura PhD, Haruaki Ishibashi MD, Kazuyosi Takeshita PhD & Yang Liu MD

  4. Peritoneal Dissemination Center, Kusatsu General Hospital, Kusatsu, Shiga, Japan

    Yutaka Yonemura PhD, Masamitu Hirano PhD, Akiyoshi Mizumoto PhD, Kousuke Noguchi PhD, Nobuyuki Takao MD & Masumi Ichinose PhD

  5. Department of Peritoneal Surface Oncology, Beijing Shijitan Hospital of Capital Medical University, Beijing, China

    Yan Li PhD

Authors
  1. Yutaka Yonemura PhD
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  2. Haruaki Ishibashi MD
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  3. Masamitu Hirano PhD
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  4. Akiyoshi Mizumoto PhD
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  5. Kazuyosi Takeshita PhD
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  6. Kousuke Noguchi PhD
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  7. Nobuyuki Takao MD
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  8. Masumi Ichinose PhD
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  9. Yang Liu MD
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  10. Yan Li PhD
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Corresponding author

Correspondence to Yutaka Yonemura PhD.

Electronic Supplementary Material

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10434_2016_5487_MOESM1_ESM.eps

Fig. 1 Treatment schedule of NLHIPEC and NIPS. PCI count, cytological status, and ascites volume at NLHIPEC were compared with those at laparotomy. * i.p. docetaxel + CDDP: i.p. administration of docetaxel (30 mg/m2) and CDDP (30 mg/m2) with 500 ml of saline; # i.v. docetaxel + CDDP: i.v. administration of docetaxel (30 mg/m2) and CDDP (30 mg/m2). NLHIPEC neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion, NIPS neoadjuvant intraperitoneal/systemic chemotherapy, PCI Peritoneal Cancer Index, i.p. intraperitoneal, i.v. intravenous, CDDP cisplatin (EPS 603 kb)

10434_2016_5487_MOESM2_ESM.eps

Fig. 2 Survival curves of patients who received NLHIPEC plus NIPS. Patients with a PCI score ≤11 (N = 35) at the time of CRS survived significantly longer than those with a PCI score ≥12 (N = 17) [Chi-square 5.93; p = 0.015]. NLHIPEC neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion, NIPS neoadjuvant intraperitoneal/systemic chemotherapy, PCI Peritoneal Cancer Index, CRS cytoreductive surgery (EPS 460 kb)

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Yonemura, Y., Ishibashi, H., Hirano, M. et al. Effects of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy and Neoadjuvant Intraperitoneal/Systemic Chemotherapy on Peritoneal Metastases from Gastric Cancer. Ann Surg Oncol 24, 478–485 (2017). https://doi.org/10.1245/s10434-016-5487-6

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  • DOI: https://doi.org/10.1245/s10434-016-5487-6

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