Problems with intraoperative hyperthermic peritoneal chemotherapy for advanced gastric cancer

Background Intraoperative hyperthermic peritoneal chemotherapy (IHPC) after total gastrectomy for advanced, serosa-penetrating gastric cancer has been demonstrated in several studies to reduce the incidence of peritoneal carcinosis and to prolong survival. Methods In a prospective pilot study, nine patients with advanced gastric cancer were selected to receive IHPC with Mitomycin and Cisplatin after total gastrectomy and systematic lymphadenectomy. Results All patients had nodal, and four patients distant, metastases. Six patients (66%) suffered from post-operative complications including renal failure, pancreatitis, pancreatic fistula and anastomotic dehiscence. Thirty-day mortality was zero. Six patients died within 3–10 months after surgery. Five of these deaths were related to peritoneal carcinosis and one patient died from cardiac failure 3 months after surgery. Three patients, respectively, have been alive for 12, 20 and 24 months at present, with suspected peritoneal tumour in the last patient. The 2-year probability of survival among our patients receiving IHPC is 29%. Conclusion Intraoperative hyperthermic peritoneal chemotherapy carries a high risk of peri-operative complications and was not able to prevent or delay peritoneal tumour recurrence in patients with advanced gastric cancer.