Prediction of Metastasis after Curative Surgery in Patients with Castric Cancer and its Prophylactic Management by Introduction of Type Oriented Chemotherapy

Masayoshi Mai, Yutaka Takahashi, Toshihiro Fujimoto

Department of Surgery, Cancer Research Institute Hospital, Kanazawa University

Although there has been recent progress in gastric surgery, our clinical series supports that in half of advanced gastric cancer cases of stage III and IV the tumor recurs and leads to complication of the peritoneal cavity, liver or distant organs even if curative resection might be possible. From the viewpoint of the new classification of cellular behavior gastric cancer tumors can be divided into two types: (1) the localized and expanding type with medullary stroma which shows hematogenous organ metastasis, most often affecting liver through venous and circulating disperson, and (2) the infiltratively penetrating type which widely infiltrates through gastric wall rather than forming a mass, often associated with peritoneal seeding. The present study was designed to assess two high-risk groups of metastatic patterns, peritoneal dissemination and liver metastasis, based on multivariate analysis of histopathology and tumor markers. First, intraperitoneal lavage of high-dose MMC and OK432 was indicated for the group of high risk for peritoneal recurrence (12 patients with excellent postoperative survival). Secondly, a one-shot infusion of MMC and 5-Fu via the hepatic artery was performed for 41 high-risk patients during surgery. Favorable results on disease-free survival were obtained in the arterial infusion group. Our result indicates that prophylactic and locoregional chemotherapy during surgery might be effective as antitumor treatment against microresidual cancer cells in gastric cancer patients of high risk for peritoneal and hepatic recurrence.

Key words
advanced gastric carcinoma, high risk for peritoneal and hepatic recurrence, intraoperative chemotherapy

Reprint requests
Masayoshi Mai Department of Surgery, Cancer Research Institute Hospital, Kanazawa University
4-86 Yoneizumi, Kanazawa, 921 JAPAN

Accepted
December 8, 1993

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