Effect of Surgical Treatment and Continuous Hyperthermic Peritoneal Perfusion for Borrmann Type 4 Gastric Cancer

Abstract

Of 61 patients with Borrmann type 4 gastric cancer (B4GC) the 1-and 3-year survival rates of curability A patients (n=18) were 94 and 60%; those of curability B (n=9), curability C (n=24), and no resection (n=10) patients were 56 and 11%, 46 and 0%, and 0 and 0%, respectively. The survival curve of the curability A group was significantly better than any other groups (p<0.01). In prophylactic continuous hyperthermic peritoneal perfusion (CHPP) for B4GC with serosal invasion and PO or P1 peritoneal seedings, 2-and 4-year survival rates of the CHPP (+) group were 90 and 56%, significantly higher than the 67 and 27% of the CHPP (-) group (p=0.02). In therapeutic CHPP for B4GC with P2 or P3 peritoneal seedings, the survival curve of the CHPP (+) group was significantly better than that of the CHPP (-) group (p=0.04). But no patient with P2 or P3 peritoneal seedings survived over 3 years. These results suggested that curability A or B resection and prophylactic CHPP for PO or P1 peritoneal seedings prolonged survival in B4GC, but the prognosis of B4GC with P2 or P3 peritoneal seedings was not ameliorated by therapeutic CHPP. New treatment modalities, such as neoadjuvant chemotherapy, need to be developed against severe peritoneal seedings.