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Laparoscopic Hyperthermic Intraperitoneal Chemotherapy is Safe for Patients with Peritoneal Metastases from Gastric Cancer and May Lead to Gastrectomy

  • Timothy E. Newhook
  • Annamaria Agnes
  • Mariela Blum
  • Jeannelyn S. Estrella
  • Prajnan Das
  • Linus Ho
  • Jaffer A. Ajani
  • Bruce D. Minsky
  • Paul Mansfield
  • Brian D. BadgwellEmail author
Gastrointestinal Oncology

Abstract

Background

Laparoscopic hyperthermic intraperitoneal chemotherapy (LS-HIPEC) is a novel strategy for patients with gastric adenocarcinoma (GA) metastatic to the peritoneum. We evaluated the safety profile of LS-HIPEC for patients with positive peritoneal cytology (PPC) or carcinomatosis from GA.

Methods

Outcomes were reviewed of patients with stage IV GA with peritoneal involvement who received LS-HIPEC from June 2014 to January 2017. LS-HIPEC included a 60-minute perfusion of mitomycin-C (30 mg) and cisplatin (200 mg) with inflow temperatures of 41–42 °C and outflow temperatures of 39–40 °C.

Results

A total of 71 LS-HIPEC procedures were performed in 44 patients. At diagnosis, 68% (n = 30) had carcinomatosis and 32% (n = 14) had isolated PPC. Three patients (7%) underwent LS-HIPEC for intractable ascites. All patients initially received systemic chemotherapy, and 20 patients (45%) received pre-procedural chemoradiotherapy. The median number of LS-HIPEC procedures performed per patient was one (range 1–5 procedures). There were no conversions to laparotomy, two outflow catheter obstructions, and one major (Clavien-Dindo grade III) surgical complication within 30 days. A total of seven postoperative adverse hematologic events (> CTCAE 2) were observed in five patients (11%), without any major renal or gastrointestinal adverse events within 30 days. The median overall length of hospital stay after LS-HIPEC was 2 (range 2–11) days. Eleven patients (25%) underwent secondary gastrectomy following resolution of peritoneal cytology.

Conclusions

Laparoscopic HIPEC is a safe procedure and may be repeated in patients with peritoneal metastases from gastric cancer. Future studies are required to determine the optimal HIPEC regimen and timing relative to systemic therapy to best minimize morbidity.

Notes

Disclosure

No conflicts of interest to disclose.

References

  1. 1.
    AJCC. Stomach cancer. In: Edge S, Byrd D, Compton C, et al., eds. Cancer staging manual, 7th edn. New York: Springer; 2010:117–26.Google Scholar
  2. 2.
    Badgwell B, Cormier JN, Krishnan S, et al. Does neoadjuvant treatment for gastric cancer patients with positive peritoneal cytology at staging laparoscopy improve survival? Ann Surg Oncol. 2008;15(10):2684–91.CrossRefGoogle Scholar
  3. 3.
    Ikoma N, Blum M, Chiang YJ, et al. Yield of staging laparoscopy and lavage cytology for radiologically occult peritoneal carcinomatosis of gastric cancer. Ann Surg Oncol. 2016;23(13):4332–37.CrossRefGoogle Scholar
  4. 4.
    Jacquet P, Sugarbaker PH. Peritoneal-plasma barrier. Cancer Treat Res. 1996;82:53–63.CrossRefGoogle Scholar
  5. 5.
    Flessner MF. The transport barrier in intraperitoneal therapy. Am J Physiol Renal Physiol. 2005;288(3):F433–42.CrossRefGoogle Scholar
  6. 6.
    Yonemura Y, Canbay E, Endou Y, et al. Peritoneal cancer treatment. Expert Opin Pharmacother. 2014;15(5):623–36.CrossRefGoogle Scholar
  7. 7.
    Yonemura Y, Canbay E, Li Y, et al. A comprehensive treatment for peritoneal metastases from gastric cancer with curative intent. Eur J Surg Oncol 2016;42(8):1123–31.CrossRefGoogle Scholar
  8. 8.
    Facchiano E, Risio D, Kianmanesh R, et al. Laparoscopic hyperthermic intraperitoneal chemotherapy: indications, aims, and results: a systematic review of the literature. Ann Surg Oncol. 2012;19(9):2946–50.CrossRefGoogle Scholar
  9. 9.
    M.D. Anderson Cancer Center. Study of cytoreduction, gastrectomy, & hyperthermic intraperitoneal chemoperfusion (HIPEC) in gastric adenocarcinoma and carcinomatosis or positive cytology. Available at: https://www.clinicaltrials.gov/ct2/show/NCT02891447. Accessed 4 June 2018.
  10. 10.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.CrossRefGoogle Scholar
  11. 11.
    Shiozaki H, Elimova E, Slack RS, et al. Prognosis of gastric adenocarcinoma patients with various burdens of peritoneal metastases. J Surg Oncol. 2016;113(1):29–35.CrossRefGoogle Scholar
  12. 12.
    Badgwell B, Blum M, Das P, et al. Phase II trial of laparoscopic hyperthermic intraperitoneal chemoperfusion for peritoneal carcinomatosis or positive peritoneal cytology in patients with gastric adenocarcinoma. Ann Surg Oncol. 2017;24(11):3338–44.CrossRefGoogle Scholar
  13. 13.
    Mezhir JJ, Shah MA, Jacks LM, et al. Positive peritoneal cytology in patients with gastric cancer: natural history and outcome of 291 patients. Ann Surg Oncol. 2010;17(12):3173–80.CrossRefGoogle Scholar
  14. 14.
    Badgwell B, Roy-Chowdhuri S, Chiang YJ, et al. Long-term survival in patients with metastatic gastric and gastroesophageal cancer treated with surgery. J Surg Oncol. 2015;111(7):875–81.CrossRefGoogle Scholar
  15. 15.
    Sun J, Song Y, Wang Z, et al. Benefits of hyperthermic intraperitoneal chemotherapy for patients with serosal invasion in gastric cancer: a meta-analysis of the randomized controlled trials. BMC Cancer. 2012;12:526.CrossRefGoogle Scholar
  16. 16.
    Coccolini F, Cotte E, Glehen O, et al. Intraperitoneal chemotherapy in advanced gastric cancer. Meta-analysis of randomized trials. Eur J Surg Oncol. 2014;40(1):12–26.CrossRefGoogle Scholar
  17. 17.
    Glehen O, Gilly FN, Arvieux C, et al. Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol. 2010;17(9):2370–7.CrossRefGoogle Scholar
  18. 18.
    Magge D, Zenati M, Mavanur A, et al. Aggressive locoregional surgical therapy for gastric peritoneal carcinomatosis. Ann Surg Oncol. 2014;21(5):1448–55.CrossRefGoogle Scholar
  19. 19.
    Yonemura Y, Ishibashi H, Hirano M, et al. Effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy and neoadjuvant intraperitoneal/systemic chemotherapy on peritoneal metastases from gastric cancer. Ann Surg Oncol. 2017;24(2):478–85.CrossRefGoogle Scholar
  20. 20.
    Ajani JA, D’Amico TA, Almhanna K, et al. Gastric cancer, version 3.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14(10):1286–312.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Timothy E. Newhook
    • 1
  • Annamaria Agnes
    • 1
  • Mariela Blum
    • 2
  • Jeannelyn S. Estrella
    • 3
  • Prajnan Das
    • 4
  • Linus Ho
    • 2
  • Jaffer A. Ajani
    • 2
  • Bruce D. Minsky
    • 4
  • Paul Mansfield
    • 1
  • Brian D. Badgwell
    • 1
    Email author
  1. 1.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of PathologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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