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Gastroenterology Research and Practice
Volume 2012 (2012), Article ID 521487, 10 pages
http://dx.doi.org/10.1155/2012/521487
Clinical Study

Surgical Results of Patients with Peritoneal Carcinomatosis Treated with Cytoreductive Surgery Using a New Technique Named Aqua Dissection

1NPO Organization to Support Peritoneal Surface Malignancy Treatment, 1-26, Haruki-Moto-Machi, Kishiwada, Osaka, Japan
2Department of Surgery, Kusatsu General Hospital, Shiga, Japan
3Department of Surgery, Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada, Japan
4Department of Experimental Therapeutics, Cancer Research Institute, Kanazawa University, Kanazawa, Japan
5Department of Anatomy, School of Medicine, Oita University, Oita, Japan
6Department of Oncology, Zhongnam Hospital and Cancer Center, Wuhan University, Wuhan, China

Received 14 January 2012; Accepted 11 March 2012

Academic Editor: Pompiliu Piso

Copyright © 2012 Y. Yonemura et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

During 2004 to 2011, 81, 420, and 166 patients with colorectal cancer (CRC), epithelial appendiceal neoplasm (APN), and gastric cancer (GC) with PC were treated with cytoreductive surgery (CRS) plus perioperative chemotherapy. CRS was performed by peritonectomy techniques using an aqua dissection. Results. Complete cytoreduction was done in 62/81 (76.5%), 228/420 (54.3%), and 101/166 (60.8%) of patients with CRC, APN, and GC. The main reasons of incomplete resections were involvement of all peritoneal regions and diffuse involvement of small bowel. The incidence (64%, 302/470) of CC-0 resection after introduction of an aqua dissection was significantly higher than before (42%, 82/197). A total of 41 (6.1%) patients died postoperatively. Major complication (grade 3-4 complications) occurred in 126 patients (18.9%). A reoperation was necessary in 36 patients (5.4%). By the multivariate analysis, PCI scores capable of serving as thresholds for favorable versus poor prognosis in each group and CC scores demonstrated as the independent prognostic factors. Conclusions. Peritonectomy using an aqua dissection improves the incidence of complete cytoreduction, and improves the survival of patients with PC. Patients with PCI larger than the threshold values should be treated with chemotherapy to improve the incidences of complete cytoreduction.