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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. Jul 28, 2015; 5(2): 187-197
Published online Jul 28, 2015. doi: 10.5412/wjsp.v5.i2.187
Comprehensive treatment for the peritoneal metastasis from gastric cancer
Yutaka Yonemura, Emel Canbay, Yoshio Endou, Haruaki Ishibashi, Akiyosi Mizumoto, Yan Li, Yang Liu, Kazuyoshi Takeshita, Masumi Ichinose, Nobuyuki Takao, Takuya Saitou, Kousuke Noguchi, Masamitu Hirano, Oliver Glehen, Bjorn Brűcher, Paul H Sugarbaker
Yutaka Yonemura, Emel Canbay, Haruaki Ishibashi, Akiyosi Mizumoto, Yang Liu, Kazuyoshi Takeshita, Masumi Ichinose, Nobuyuki Takao, Takuya Saitou, Kousuke Noguchi, Masamitu Hirano, NPO to Support Peritoneal Surface Malignancy Treatment, Oosaka, Kishiwada 596-0032, Japan
Yutaka Yonemura, Emel Canbay, Haruaki Ishibashi, Akiyosi Mizumoto, Yang Liu, Kazuyoshi Takeshita, Masumi Ichinose, Nobuyuki Takao, Takuya Saitou, Kousuke Noguchi, Masamitu Hirano, Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Center, Kishiwada Tokusyukai Houspital, Kusatsu General Hospital, Shiga 600-8189, Japan
Yoshio Endou, Department of Experimental Therapeutics, Cancer Research Institute, Kanazawa University, Kanazawa 926-1192, Japan
Yan Li, Yang Liu, Department of Surgery, Wuhan University, Wuhan 430000, Hubei Province, China
Oliver Glehen, Dēpartement de Chirurgie Gēnerale, Centre Hospitalier Lyon-Sud Hospices Civils de Lyon, Universitē Lyon, 69364 Lyon, France
Bjorn Brűcher, Surgical Oncology, Department of Surgery, Tűbingen Comprehensive Cancer center, University of Tűbingen, 42001-72009 Tűbingen, Germany
Paul H Sugarbaker, Center of Gastrointestinal Malignancies, Program in Peritoneal Surface Malignancies, MedStar Washington Hospital Center, Washington, DC 20010, United States
Author contributions: All the authors contribute to this paper in the design, acquisition of data, and analysis of data.
Conflict-of-interest statement: Authors state no conflict of interest and have received no payment in preparation of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yutaka Yonemura, MD, PhD, Director, NPO to Support Peritoneal Surface Malignancy Treatment, Oosaka, Kishiwada 596-0032, Japan. y.yonemura@coda.ocn.ne.jp
Telephone: +81-075-7465895 Fax: +81-075-7465895
Received: July 13, 2014
Peer-review started: July 13, 2014
First decision: September 28, 2014
Revised: February 15, 2015
Accepted: March 16, 2015
Article in press: March 18, 2015
Published online: July 28, 2015
Processing time: 359 Days and 22.4 Hours
Abstract

Recently, a novel comprehensive treatment consisting of cytoreductive surgery (CRS) and perioperative chemotherapy (POC) was developed for the treatment of peritoneal metastasis (PM) with a curative intent. In the treatment, the macroscopic disease is completely removed by the peritonectomy techniques in combination with POC. This article reviews the results of the comprehensive treatment for PM from gastric cancer, and verifies the effects of CRS and POC, including neoadjuvant chemotherapy (NAC) and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC). Completeness of cytoreduction, peritoneal carcinomatosis index (PCI) less than the threshold levels after NAC, absence of ascites, cytologic status, pathologic response after NAC are the independent prognostic factors. Among these prognostic factors, PCI threshold level is the most valuable independent prognostic factor. After staging laparoscopy, patients with PM from gastric cancer are recommended to treat with NAC before CRS. After NAC, indication for CRS is determined by laparoscopy. The indications of the comprehensive treatment are patients with PCI less than the threshold levels, negative cytology, and responders after NAC. Patients satisfy these factors are the candidates for the CRS and HIPEC.

Keywords: Gastric cancer; Hyperthermic intraoperative intraperitoneal chemotherapy; Peritoneal metastasis; Peritonectomy

Core tip: This article reviews the results of the comprehensive treatment for peritoneal metastasis from gastric cancer, and verifies the effects of cytoreductive surgery and perioperative chemotherapy, including neoadjuvant chemotherapy (NAC), and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC). Multivariate analyses revealed that the completeness of cytoreduction, peritoneal cancer index less than the threshold levels after NAC, cytologic status, pathologic response after NAC are the independent prognostic factors. Patients satisfying these factors are recommended to undergo D2-gastrectomy combined with complete removal of PC and HIPEC.