Factibilidad de la cirugía radical tipo D2 con peritonectomía y quimioterapia intraperitoneal en pacientes con cáncer gástrico resecable. Un estudio piloto

Abstract

Introduction: Gastric cancer is one of the most common neoplasias in Mexico. Unfortunately is common in advanced stages. Surgical treatment is the principal way to management gastric cancer in advanced stages as a form to prolong overall survival. Multimodal treatment is an standard for these stages. Research of other modalities have resulted due to bad prognosis with these treatments. Peritonectomy with intraperitoneal chemotherapy had prolonged overall survival en advanced gastric cancer. A pilot study was developed to know these results in our institution. Material and Methods: A pilot study was approved by ethic and research committee. Inclusion criteria were aged 70 years old or younger with gastric Adenocarcinoma. Eastern Corporative Oncological Group. (ECOG) II or less. Peritoneal disease P1 or P2 of the Japanese classification or ICP<20. Resecable by tomography with curable intent. No inclusion criteria were diseases do not permit a major abdominal surgery, previous abdominal surgery, liver or extraabdominal metastases, good performance status in heart, kidney and lungs functions. Pacemaker used, unable to receive intraperitoneal chemotherapy, gastric surgery, another diagnosis of cancer and no radio or chemotherapy treatment. The surgical procedure consist in total gastrectomy, splenectomy, cholecistectomy, hysterectomy with ooforectomy, left hemi diaphramga peritonectomy, right hemi diaphragm peritonectomy, right paracolic gutter, left paracolic gutter, Douglas pouch, Anterior wall peritoneum, greater omentum, lesser omentum, and lymphadenectomy D2, and remove of small or great bowel l affected with the goal of a complete cytoreduction. A tenkhoff catheter was applied to peritoneal chemotherapy based with cispltino (100mg/m2) and 5-FU (450mg/m2/d for three days).Data were collected in a page Página 12 de 85 designed to it. Complications, hospital stay, intensive care unit stay and treatment adherence were measure. Results: Four patients underwent a surgical procedure. ICP Surgical findings were 15, 3, 1 y 1 respectively. Peritonectomies performed were 6, 5, 5 y 2 respectively. Surgical time were 7.5 hrs mean (6:50- 8:30). Total gastrectomy was done in three cases. Anastomisis per patient were three, three, two and two respectively. Blood and plasma transfusion were required in all cases, complications during surgery was present in one case, has to receive mechanical ventilation. To pass to the intensive care unit. ICU stayed were four, one, four and one respectively. Total hospital stayed were mean 38.7 days (22-47). Oral feeding was with a mean 10 days (6-19) Chemotherapy intraperitoneal pos operative was just in one case. Rate three or major complications were presented in all cases, two cases died. Surgical stages were IV, IV, IIIA and IIIB respectively. Conclusions: ethical considerations in base of major complications a pilot study was stopped. Radical peritonectomies had abdominal surgical complications that do not permit chemotherapy delivery to the peritoneal cavity, also produce catheter malfunction that has to be removed. We do not recommended this radical surgical technique because major adverse effects. A lot of human resources and materials are consumed to treat patients with a prolonged hospital stance. We must look for equilibrium between radicalism and palliation of the patients with gastric cancer advanced.