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International Journal of Surgical Oncology
Volume 2012, Article ID 148420, 8 pages
Research Article

Effects of Neoadjuvant Intraperitoneal/Systemic Chemotherapy (Bidirectional Chemotherapy) for the Treatment of Patients with Peritoneal Metastasis from Gastric Cancer

1NPO Organization to Support Peritoneal Surface Malignancy Treatment, Osaka, Kishiwada 596-0032, Japan
2Department of Surgery, Kusatsu General Hospital, Shiga, Kusatsu 525-8585, Japan
3Department of Surgery, Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada 596-8522, Japan
4Peritoneal Dissemination Program, Kishiwada Tokushukai Hospital and Kusatsu General Hospital, NPO Organization to Support Peritoneal Surface Malignancy Treatment, 1-26, Haruki-Moto-Machi, Osaka, Kishiwada City, 596-0032, Japan
5Department of Surgery, Tanta University Hospital, Tanta, Egypt
6Department of Experimental Therapeutics, Cancer Research Institute, Kanazawa University, Kanazawa 920-1192, Japan
7Department of Anatomy, School of Medicine, Oita University, Oita 870-1192, Japan
8Department of Oncology, Zhongnan Hospital, Cancer Center of Wuhan University, Wuhan 430072, China

Received 13 January 2012; Accepted 29 April 2012

Academic Editor: Lapo Bencini

Copyright © 2012 Yutaka 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.


Novel multidisciplinary treatment combined with neoadjuvant intraperitoneal-systemic chemotherapy protocol (NIPS) and peritonectomy was developed. Ninety-six patients were enrolled. Peritoneal wash cytology was performed before and after NIPS through a port system. Patients were treated with 60 mg/m2 of oral S-1 for 21 days, followed by a 1-week rest. On days 1, 8, and 15, 30 mg/m2 of Taxotere and 30 mg/m2 of cisplatin with 500 mL of saline were introduced through the port. NIPS is done 2 cycles before surgery. Three weeks after NIPS, 82 patients were eligible to intend cytoreductive surgery (CRS) by gastrectomy + D2 dissection + periotnectomy to achieve complete cytoreduction. Sixty-eight patients showed positice cytology before NIPS, and the positive cytology results became negative in 47 (69%) patients after NIPS. Complete pathologic response on PC after NIPS was experienced in 30 (36.8%) patients. Stage migration was experienced in 12 patients (14.6%). Complete cytoreduction was achieved in 58 patients (70.7%). By the multivariate analysis, complete cytoreduction and pathologic response became a significantly good survival. However the high morbidity and mortality, stringent patient selection is important. The best indications of the therapy are patients with good pathologic response and , which are supposed to be removed completely by peritonectomy.