Abstract

Yutaka Yonemura*, Haruaki Ishibashi, Shouzou Sako, Akiyoshi Mizumoto, Syunsuke Motoi, Kazuo Nishihara, Nobuyuki Takao, Masumi Ichinose, Sachio Fushida and Yang Liu

ABSTRACT

Background: Adjuvant chemotherapy is thought to improve postoperative survival in gastric cancer (GC) patients with peritoneal metastasis (PM). Effects of neoadjuvant intraperitoneal/systemic chemotherapy (NIPS) were studied. Materials and Methods: Exploratory laparoscopy was performed in 55 GC-patients with PM. PM was evaluated using the peritoneal cancer index (PCI). A peritoneal port was introduced, and a series of 3-week cycles of NIPS was performed. Four weeks after 3 cycles of NIPS, laparotomy for cytoreductive surgery (CRS) was performed. Results: During NIPS, patients had grade 3 and 4 side effects, respectively. Before NIPS, cytology was positive in 39 (75%) patients, and changed from positive to negative in 28 (71.8%) after NIPS. PCI was significantly lower after NIPS (7.63±9.28) than before NIPS (10.6±8.38) (P=0.006). There was complete disappearance of PM in 5 (9.1%) patients, decrease in PCI in 21 (38.2%), and increase in PCI level in 12 (21.8%) patients. After NIPS, The GC in 9 patients were diagnosed as inoperable. Cytoresuction was complete in 40 of 46 patients who received laparotomy. Down-staging by NIPS was found in 14.5% (8/55) of patients. Overall median survival time (MST) after NIPS was 21.9 months, and 5-year survival rate was 18.2%. The MST was 24.1 months in the 40 patients who received complete cytoreduction was 24.1 months and 9.6 months in the 6 patients who received incomplete cytoreduction, and 9.6 patients with inoperable GC (p