Application Of Intraoperative Hypotonic Peritoneal Chemo-hyperthermia Combined With Early Postoperative Intraperitoneal Chemotherapy For Gastric Cancer

Gastric cancer remains to be one of the most common malignant diseases. For the cases of middle and advanced stage, therapeutic effect is unsatisfied mainly because of intraperitoneal recurrence and liver metastasis. It is proved that exfoliated intraperitoneal cancer cells resulted in the recurred leisions. Modern gastric carcinoma radical operation should include adequate gastrodectomy edge, rational local lymphodectomy and eliminating petitoneal exfoliated cancer cells, which is solitarily a indicated factor for unfavourable prognosis. It is reported that the positive rate of petitoneal exfoliated cells is associated significantly with invasive depth, differentiation, lymph node metastasis and invasiveness of seracosa and peritissue. However, any operation is unhelpful for clearance of the exfoliated cancer cells.The ideal chemotherapy should aim to resected region, petitoneal implanted lesion, and liver metastasis. Compared with perivein chemotherapy, intraperitoneal chemotherapy has a far more pharmacokinetic advantage, as a kind of selective regional chemotherapy.Objective: To investigate the risk factors related with high level of detecting exfoliated gastric cancer cells in petitoneal washes, to evaluate the value of operation and intraperitoneal chemotherapy respectively in eliminating exfoliated cancert cells, to evaluate the value of application of combined therapy of intraoperative hypotonic petitoneal chemo-hyperthemia and early postopetative intrapetitoneal chemotherapy for gastric cancer a, to explore the indications and procedures for this treatment and to evaluate its side effects.Methods: Petitoneal lavage cytology was used to detect the exfoliated cells in peritoneal washes during laparotomy. 156 gastric cancer patients were given respectively the combined therapy, intraoperative chemotherapy and no intraperitoneal chemotherapy and followed up.Results: The rate of positive detection of gastric cancer exfoliated cells in petitoneal washes was significantly correlated with tumor location, TNM classification, overexpression of nm23 gene, and operation style. The rate of chemical peritonitis in the combined-therapy group was higher significantly than in the control groups. The rate of liver metastasis in combined group and only intraopetive chemotherapy group was lower significantly than in no intraopetitoneal chemotherapy group.Conclusion: Several related risk factors including operation procedure are associated with high level of detecting exfoliated gastric cancer cells in peritoneal washes. Chemical petitonitis should be prevented and cured during intraoperative and early postoperative intraperitoneal chemotherapy. The combined application of intraoperative hypotonic chemo-hyperthermia and early postoperatively intrapetitoneal chemothetapy is observed effective for the exfoliated-cell positive cases and, in addition, negative cases with TNM-classificated stage of a and b. However, the effect of only intraoperative peritoneal chemotherapy remains to be proved. Intrapetitoneal chemotherapy is observed preventive for postoperative gastric cancer patients with liver metastasis.