[Extended treatment for gastric cancer patients with peritoneal seeding]

Fourteen patients with far-advanced gastric cancer were treated surgically followed by intraperitoneal hyperthermic perfusion (IPHP) with mitomycin C (MMC) and misonidazole (MIS), a thermosensitizing drug. Immediately after extensive resection of the abdominal tumors, a 2-hour IPHP was performed at the inflow temperature 47.4 +/- 0.5 degrees C and at the outflow temperature 45.3 +/- 0.5 degrees C, using equipment designed for treatment of cancerous peritoneal seeding, as a closed circuit, and under hypothermic general anesthesia at 31.2 +/- 0.5 degrees C. In 6 of the 14 patients, cancerous ascites was absent after IPHP. Repeated cytologic examination of the lavage from pelvic cul-de-sac were negative, in all cases. The postoperative courses were uneventful except for 2 patients, in whom slight leakage occurred. All patients were discharged, and 4 in the 14 patients died of recurrence in the liver, abdominal and/or pleural cavities 8.8 +/- 2.1 months after IPHP. The remaining 10 are in good health 12.1 +/- 3.1 months after IPHP. Transient hepatic dysfunction and hypoproteinemia occurred after hyperthermia in all cases. This extensive surgery combined with IPHP using MMC and MIS was well tolerated and is a safe anti-tumor treatment for gastric cancer with peritoneal dissemination. Neurotoxicity due to MIS was nil.