In approximately 80% of patients with
scirrhous carcinoma of the stomach, recurrence of
cancers occurs even after potentially curative resection, and recurrence most frequently occurs in the form of peritoneal
metastasis. Such recurrence may be attributable to possible intraperitoneal dissemination of malignant cells already present at the time of surgery. We performed intraoperative peritoneal cytology on patients with
scirrhous carcinoma of the stomach. Free
cancer cells were demonstrated in the Douglas cavity in 16 of 32 (50%) patients who underwent potentially curative
gastrectomy. The postoperative 5-year survival rate was 23% in patients without detectable free
cancer cells in the peritoneal cavity, compared with only 9% in patients with microscopic evidence of intraperitoneal free
cancer cells. Therefore, we have applied hyperthermic continuous peritoneal perfusion (CHPP) on patients with
scirrhous carcinoma of the stomach in order to develop a surgical adjuvant
therapy effective for the prevention of recurrence of peritoneal involvement. The results obtained so far from our study have shown an increased 3-year survival rate of patients undergoing potentially curative
gastrectomy, but no improvement of therapeutic outcome in terms of postoperative 5-year survival.