Intraperitoneal Chemotherapy Against Serosal Invasion and Peritoneal Dissemination of Gastric Cancer with Activated Carbon Particles Adsorbing Mitomycin C: Prognosis and Complications

Lee, Kaown Jee; Yang, Doo Hyun

Abstract

Peritoneal carcinomatosis is a common cause of noncurability and the most common type of recurrence in surgical operations for gastric cancer. Activated carbon particles are taken up selectively by lymphatic tissues, which seem to be a primary site of peritoneal carcinomatosis in the peritoneal cavity, and adsorb a large amount of anticancer agent, such as mitomycin C, which is subsequently released slowly and for long periods. We carried out a retrospective study to determine if activated carbon particles adsorbing mitomycinC ( MMC-CH ) could improve the survival of patients who underwent radical resection for gastric cancer with serosal invasion and peritoneal dissemination and to evaluate the prognostic factors in patients receiving intraperitoneal MMC-CH therapy from January 1993 to January 1996. Those in the control group received no intraperitoneal chemotherapy and those in the MMC-CH group were given 50mg mitomycinC as MMC-CH before the surgical wound closure into the peritoneal cavity. The 3-year survival rates for the MMC-CH group in the case of S2 were 55%, and 17% in the case of S3. But the 3-year survival rate for the control group in the case of S2 was 32% and there was no survivor in S3 cases. In the cases of peritoneal dissemination, there were no survivor for the control group, but the 3-year survival rate for the MMC-CH group was 13%. The difference between the two groups was not statistically significant except positive papanicolaou smear and S3 cases at 3-year survival rates. There was a significant difference in morbidity after surgery between these two groups especially due to fever & hypotension and anastomotic leakage. Multivariative analysis using simple regression model in MMC-CH group has confirmed that the serosal invasion, positive Pap. smear and high stage had a significant impact on the survival rate after gastric resection. In conclusion, intraperitoneal chemotherapy with MMC-CH is effective in prolonging the survival time by prophylatic effect on peritoneal recurrence after curative resection of gastric cancer without significant complication and especially indicated in the cases of positive serosal invasion, positive Pap. smear in peritoneal cytology and high stage.