Effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion and intraperitoneal/systemic chemotherapy on peritoneal metastasis from gastric cancer | Journal of Peritoneum (and other serosal surfaces)

Our aim was to clarify the effects of neoadjuvant hyperthermic intraperitoneal chemoperfusion (NLHIPEC) followed by intraperitoneal/systemic chemotherapy (NIPS) on peritoneal metastasis from gastric cancer. After carrying out exploratory laparoscopy to determine the peritoneal cancer index (pretreatment PCI: Pre-PCI) in 150 patients, we performed NLHIPEC for 60 min. with peritoneal port placement: a series of 3-week cycles of NIPS using S1, docetaxel, and cisplatin two weeks after NLHIPEC: performed cytoreductive surgery in 86 patients four weeks after NIPS, and subsequently measured PCI (Post-PCI). Positive cytology in 38 patients changed to negative in 26 (68.4%) patients at laparotomy. The post-PCI (6.7±7.8) was significantly lower than the pre-PCI (10.6±10.2) (P=0.0001). The PCI was ≥14 in 30 patients at pretreatment and ≤13 in 19 (63.3？？) of these patients at posttreatmjent. Post-PCI cut-off level (≤13 vs ≥14) and cytology after NIPS (negative vs positive) emerged as independent indicators of prognosis. Postoperative mortality was 1.2% (1/86). NLHIPEC and NIPS are safe and effective modalities for reducing Post-PCI below the cut-off level and eradicating peritoneal free cancer cells