Surgical Treatment and Effects of Chemotherapy for Gastric Carcinoma with Peritoneal Dissemination

Masatsugu Kitamura, Kuniyoshi Arai, Kaoru Miyashita

Department of Surgery, Tokyo Metropolitan Komagome Hospital

The subjects were 300 patients with gastric cancer with peritoneal metastasis discovered at laparotomy. We investigated the effects of surgical treatment and chemotherapy on the outcome of these cases. The rates of resection in P₁, P₂ and P₃ cases were 83.5%, 83.1% and 38.1%, respectively, with a total rate of 64.3%. The survival rate decreased with advance in P-progress in overall P (+) cases. There were significant differences in survival rate between P₁ and P₃ (p<0.001), and P₂ and P₃ (p<0.05). In P (+) cases with gastrectomy, there was a significant difference in survival rate between P₁ and P₃ (p<0.05). No differences in survival rate were found in non-resected cases. As for the outcome of these cases according to the degree of lymph node dissection, R₂ was significantly better than R₀ in P₁ (p<0.05). Although we augmented the degree of lymph node dissection in P₂ and P₃ cases, no significant increase in the survival rate occurred. We studied the effect of chemotherapy. Concerning the outcome of non-resected cases, the cases with chemotherapy showed significantly better results than those without chemotherapy (p<0.001). The outcome of resected cases with chemotherapy was also better than that without chemotherapy. Treatment by sequential MTX-5FU was regarded as more effective in the present investigation than 5FU, MMC·5FU and ADM·5FU therapy. Consequently, we concluded that it is necessary to determine not only appropriate operative indications and lymph node dissection but also effective chemotherapy in P (+) cases.

Key words
surgical treatment for gastric cancer with peritoneal dissemination, adjuvant chemotherapy, sequential MTX-5FU therapy

Reprint requests
Masatsugu Kitamura Department of Surgery, Tokyo Metropolitan Komagome Hospital
3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
September 12, 1990

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