[en] Aim of the study : After macroscopic radical (R0) surgery for advanced gastric carcinoma, 40 to 50% of the tumors recur in the abdomen as locoregional or peritoneal disease. We initiated a protocol in which patients with suspicion of macroscopic serosal, lymphatic or peritoneal invasion, treated with R0 resection, underwent adjuvant HIPEC.
Methods : Between June 1998 and January 2003, 16 patients with locally advanced adenocarcinoma of the stomach were included in the study. Surgery consisted of a total gastrectomy with a D2 lymphadenectomy. Splenectomy (n = 1),
splenopancreatectomy (n = 4), transverse colectomy (n = 3), left hepatectomy (n = 1), localized peritonectomy (n = 3) were associated to obtain a R0 resection. HIPEC protocol consisted of heated (42.5°C) intraperitoneal mitomycin C (15 mg/m2) for a planned duration of 90 minutes.
Results : HIPEC median duration was limited to 73(20-90) min because of central hyperthermia recognition in half of the cases. One patient died in the postoperative period of sepsis secondary to a duodenal fistula. Postoperative morbidity included pancreatic fistula (n = 2), pulmonary oedema (n = 1), pulmonary embolus (n = 1) and transient renal failure (n = 1). UICC staging was IB (n = 2), II (n = 2), IIIA (n = 5), IIIB (n = 1), IV (n = 6). Nine of the 16 patients are alive without recurrence with a median follow-up of 52 months. Four patients developed a recurrence, intraperitoneal (n = 2), systemic (n = 1), or combined (n = 1). Two patients were lost to follow-up.
Conclusions : Aggressive surgical therapy and HIPEC might represent the standard of care in a selected population with locoregional disease and for whom a R0 resection can be achieved. This protocol was associated in this study with a 75% 5-year survival with a low peritoneal recurrence rate and an acceptable morbidity.
Disciplines :
Surgery Gastroenterology & hepatology Oncology
Author, co-author :
De Roover, Arnaud ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Detroz, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Detry, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Coimbra Marques, Carla ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Polus, Marc ; Centre Hospitalier Universitaire de Liège - CHU > Gastro-Entérologie-Hépatologie
Belaiche, Jacques ; Centre Hospitalier Universitaire de Liège - CHU > Gastro-Entérologie-Hépatologie
Meurisse, Michel ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Honore, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Language :
English
Title :
Adjuvant hyperthermic intraperitoneal peroperative chemotherapy (HIPEC) Associated with curative surgery for locally advanced gastric carcinoma.An initial experience
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