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10.1245/s10434-006-9205-7
Annals of Surgical Oncology 14:61-68 (2007)
© 2007 Society of Surgical Oncology
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Original Article

Early Postoperative Intraperitoneal Chemotherapy Following Cytoreductive Surgery in Patients with Very Advanced Gastric Cancer

Jae-Ho Cheong, MD1,2, Jia Yun Shen, MD1,4, Chang Soo Song, MD1,2, Woo Jin Hyung, MD1,2, Jian Guo Shen, MD1,4, Seung Ho Choi, MD1 and Sung Hoon Noh, MD1,2,3

1 Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Korea
2 Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul 120-752, Korea
3 Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul 120-752, Korea
4 Department of Surgical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China

Correspondence: Address correspondence and reprint requests to: Sung Hoon Noh, MD, Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-dong Seodaemun-gu, Seoul 120-752, Korea; E-mail: sunghoonn{at}yumc.yonsei.ac.kr.

Background: The survival of patients with stage IV gastric cancer is poor due to frequent peritoneal failure. The aim of this study was to investigate the impact of early postoperative intraperitoneal chemotherapy (EPIC) after cytoreductive surgery on the long-term survival of these patients, as determined by residual disease status.

Methods: A total of 154 patients with stage IV gastric cancer were enrolled in our study. All patients underwent potentially curative or palliative resections. After surgery, the residual disease states of the patients were recorded. All patients received EPIC.

Results: Of all 154 patients, R0 resection was achieved in 37, R1 in 56, and R2 in 61. All patients received a mean of 4.3 EPIC perfusions. After a mean followup period of 29 months, 14 patients remained alive. The median survival of all 154 patients was 11.4 months. Survival times were analyzed according to the type of residual tumor; the median survival time was 25.5 months in the R0 group, 15.6 months in the R1 group, and 7.2 months in the R2 group (p < .001). Upon multivariate analysis, the residual tumor states and the cycle of EPIC perfusion were found to be independent prognostic predictors (p < .001 and p = .018, respectively).

Conclusions: The residual tumor status is the most important predictor for the survival of very advanced gastric cancer patients who received cytoreductive surgery and EPIC. Therefore, complete cytoreductive surgery yielding R0 resection is mandatory for achieving the beneficial effects of EPIC.

Key Words: Gastric cancer • EPIC • Cytoreductive surgery • R0 resection






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