THE ROLE OF INTRAPERITONEAL HYPERTHERMIC CHEMOPERFUSION IN THE COMPLEX TREATMENT OF PATIENTS WITH PERITONEAL-DISSEMINATED CANCER OF THE STOMACH

Abstract

The combination of gastrectomy (GE), peritoneoectomy (PE) and intraperitoneal hyperthermic chemoperfusion (IPHTC) with gastric cancer (GC) is a part of a specific medical ideology, has been implemented by a group of enthusiasts united under PSOGI ​​(Peritoneal Surface Oncology Group International – the global medical community for the study of peritoneal carcinomatosis). Over time, GE\PE\IPHTC is expected to become the standard for the combined treatment of patients with carcinomatosis in patients with gastric cancer. The experience of the Odesa Center for Reconstructive and Platic Medicine and the Odea National Medical University on the use of the method of intraperitoneal hyperthermic chemoperfusion (IPHTC) is presented in the paper. A brief prequel of some stages in the development of gastric cancer surgery was reviеwed.

The aim of the study – to consider the controversialities of world experience in the use of IPHTC (the results vary from extremly positive to rather negative), it was necessary to study the survival of patients with carcinomatosis using standard chemotherapy and HIPEC.

Materials and Methods. All in the study included 47 people who were operated in the period 2015–2017. The patients were operated at the Clinic of Reconstructive and Plastic Medicine of Odesa National Medical University. The study included only radical or conventionally radically operated patients. Average age 54.9 years, men – 14, women – 33. In order to compare the survival of patients after PE / IPHTC, a retrospective comparison group was selected, which included 22 patients with abdominal cancers, for which only intravenous systemic chemotherapy (SCh) was used.

Results and Discussion. Own observation based on the analysis of case histories of 47 patients who underwent IPHTC in stomach cancer, ovarian cancer, colorectal cancer, and some other types of malignant abdominal pathology. The survival rate of patients after HIPEC and patients with carcinomatosis of the abdominal cavity, who received only systemic chemotherapy, was compared. Survival after HIPEC was slightly worse than after systemic chemotherapy. Interest is represented by the possibility of individualization of the scheme of the IPHTC in terms of the appointment of a certain chemotheraputical drug. In this connection, the patent UA 121792 U dated 11.12.2017 is issued. Mashukov A.O., Maksimovskyi V.E., Chetverykov S.H., Lukiancuk O.V., Osadchyi D.M., Zavoloka S.O., Rosha L.H., Pyrohov V.V. Method of treating gastric cancer complicated by abdominal cavity canceromatosis. Before the procedure, a laparoscopy is carried out with a sufficient amount of material taken from the tumor tissue, followed by its immunohistochemical study on the main marker of sensitivity: TOP2A, ERCC1, TS.

Conclusions. It was concluded that, taking into account international data and data of some domestic oncology centers (Lviv Oncological Regional Center for Treatment and Diagnostic), more careful patient selection is needed based on the value of the peritoneal carcinomatosis index (PCI) and the level of planned cytoreduction.