Micrometastasis in Omental Milky Spots and Intraperitoneal Chemotherapy with Carbon-adsorbed Mitomycin C (MMC-CH) Against Peritoneal Cancer Dissemination in Gastric Cancer

Masataka Shimotsuma, Morio Shirasu, Akira Sakuyama, Norimasa Watanabe, Tsuguo Sakakibara, Hiroyuki Tsujimoto, Akeo Hagiwara, Toshiharu Yamaguchi, Kiyoshi Sawai, Toshio Takahashi

First Department of Surgery, Kyoto Prefectural University of Medicine

Peritoneal metastasis is the most common type of recurrence after a gastric cancer operation. The mechanism of this metastasis has not yet been elucidated in detail. To predict peritoneal metastasis, it is important to eliminate the mechanism of cancer dissemination in the peritoneal cavity, especially in its early stage. The lymphatic system of the peritoneal cavity maintains homeostasis and also seems to participate in intraperitoneal cancer dissemination. Omental milky spots, which are also called omentum-associated lymphoid tissue, are part of the lymphatic system in the peritoneal cavity and are located along the perivascular adipose tissues of the omentum as numerous cellular aggregations around capillary convolutions. The lymphatic capillaries in the omental milky spots take part in the absorption of various substances, including cancer cells, from the peritoneal cavity. Omental milky spots contain micrometastasis even though the omentum appears normal upon visual examination. The lymphatic system may be involved in cancer metastasis via, for example, the omental milky spots. MMC-CH is adsorbed into the lymphatic system of the peritoneal cavity and releases high concentrations of MMC. Intraperitoneal chemotherapy with MMC-CH significantly improved the survival rates of gastric cancer patients with serosal infiltration in a prospective randomized study.

Key words
intraperitoneal cancer dissemination, omental milky spots, MMC absorbed activated carbon particles

Reprint requests
Masataka Shimotsuma, First Department of Surgery, Kyoto Prefectural University of Medicine
465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602 JAPAN

Accepted
December 8, 1993

To read the PDF file you will need Abobe Reader installed on your computer.