Multidisciplinary therapy for treatment of patients with peritoneal carcinomatosis from gastric cancer

Table 1 Area under the curve ratios of intraperitoneal exposure to systemic agents

Drugs	Area under the curve ratio
5-Fluorouracil	250
Carboplatin	10
Cisplatin	7.8
Docetaxel	552
Doxorubicin	230
Etoposide	65
Gemcitabin	500
Irinotecan	N/A
Melphalan	93
Mitomycin C	23.5
Mitoxantrone	115-255
Oxaliplatin	16
Paclitaxel	1000
Pemetrexed	40.8

Table 2 Operation methods in 30 primary gastric cancer patients with PC after NIPS

Extent of gastrectomy

Total gastrectomy: 29

Distal gastrectomy: 1

LN dissection

D2 dissection: 29

D1 dissection: 1

Peritonectomy procedures

Diaphragm copula: right side 1, both side 2

Colon resection : 9

Hysterectomy + BSO: 9

Douglasectomy: 7

Small bowel/mesentery resection: 4

Falciform ligament resection: 30

Morrison Pouch resection: 29

Omentectomy: 30

Anterior leaf of transverse colon: 29

Splenectomy: 28

Completeness of cytoreduction

Complete cytoreduction: 24 (80.0%)

PC: Peritoneal carcinomatosis; NIPS: Neoadjuvant intraperitoneal-systemic chemotherapy protocol.

Table 3 Postoperative complications after 96 peritonectomy for PC from gastric cancer

Medical complication
Pulmonary complications	5 (5%)
Surgical complication
Anastomotic leakage	11 (10%)
Fistula from small bowel	4 (4%)
Abdominal abscess	4 (4%)
Bleeding	3 (3%)
Pancreatic fistula	2 (2%)
Reoperation	4 (4%)
Bleeding	1
Drainage of abscess
From leakage	1
From bowel fistula	2

Table 4 Gilly staging system

Stage	Peritoneal carcinomatosis description
Stage 0	No macroscopic disease
Stage 1	PC less than 5 mm in diameter
	localized in one part of abdomen
Stage 2	PC less than 5 mm
	Diffuse in the whole abdomen
Stage 3	PC 5 mm to 2 cm in diameter
Stage 4	Large PC more than 2 cm

Table 5 Multivariate survival analysis of 90 patients with PC

Clinicopathologic factors	χ2	P	Relative risk	95% CI levels
Sex (malevsfemale)	3.87	0.049	0.64	0.401-1.020
Age ( ≤65vs> 65)	0.08	0.653	0.74	0.098-5.595
CC (CC-0,1vsCC-23)	7.96	0.004	2.32	1.004-3.638
NIPS (donevsnot done)	5.28	0.016	3.06	1.008-4.046
PCI ( ≤6vs≥7)	0.80	0.802	0.91	0.444-1.872
Histology (diff.vspoorly diff.)	0.59	0.442	0.62	0.252-4.399

From gastric cancer, treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) (cox proportional hazard model). PCI: Peritoneal cancer index.

Table 6 recurrence patterns after curative resection of P0/Cy1 patients n (%)

	Peritoneum	Lymph node	Liver	The others
Negative	42/92 (45.6)	20/92 (21.7)	23/92 (25.0)	7/92 (7.6)
cytological status
Positive	22/27 (81.4)	2/27 (7.4)	2/27 (7.4)	1/27 (3.7)
cytological status