The State of the Art and Perspective in Treatment of Gastric Carcinoma with Reference to Depth of Invasion

Masahiro Hiratsuka, Hiroshi Furukawa, Takeshi Iwanaga, Shoji Nakamori, Seizo Masutani, Hiroaki Ohigashi, Masao Kameyama, Yo Sasaki, Toshiyuki Kabuto, Osamu Ishikawa, Hiroki Koyama, Shingi Imaoka

Department of Surgery, The Center for Adult Diseases, Osaka

Lymph node metastasis was observed in 80% of gastric carcinomas with serosal involvement. Patients with such gastric carcinomas were prone to develop carcinomatous peritonitis, and in case of type 4 gastric carcinoma, retroperitoneal dissemination of carcinoma cells was frequently seen. The 5-year actuarial survival rate was as low as 17.7% for gastric carcinoma patients with para-aortic lymph node involvement. Gastrectomy including removal of the para-aortic lymph node failed to improve the patient survival, indicating the necessity of developing a new modality to eradicate this disease. In order to prevent the peritoneal dissemination of carcinoma cells, 40 mg of mitomuycin C dissolved in 1000 ml of saline was intraperitoneally administered immediately after the surgery for gastric carcinomas with serosal involvement, and it was withdrawn 60 min later. This administration schedule was devised with reference to IC₉₀ (inhibition concentration 90) of mitomycin C obtained from in vitro studies, and found to be efficient in terms of prolonging the patient survival. This new method, however, did not prevent the development of carcinomatous peritonitis completely, indicating that another new modality should be devised. Invasion to adjacent organs was histologically seen in 18% of type 4 gastric carcinomas without evidence of macroscopic involvement. Left upper abdominal evisceration, i.e., extended radical gastrectomy including Appleby's method, resulted in the improvement of patient survival, especially by preventing carcinomatous peritonitis.

Key words
type 4 gastric cancer, microscopic invasion to adjacent organs, left upper abdominal evisceration

Reprint requests
Masahiro Hiratsuka Department of Surgery, The Center for Adult Diseases, Osaka
1-3-3 Nakamichi, Higashinari-ku, Osaka, 537 JAPAN

Accepted
December 8, 1993

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