Ascites is developed by the vasoactive cytokines, produced from intraperitoneal inflammatory cells and cancer cells. Vascular endothelial growth factor (VEGF) is a well-known cytokine, which increase the vascular permeability. VEGF mRNA is expressed from all the gastric cancer cell lines and clinical samples. VEGF produced from cancer cells increases permeability of submesothelial vasculature, and plays an important role in ascites development in gastric cancer. VEGF levels in ascites of patients with high PCI were significantly higher than those with low PCI. After wash out the ascites and peritoneal free cancer cells by LHIPEC, the intraperitoneal VEGF levels may be decreased. As a result, the pearmeability of submesothelial vasclature may be decreased, resulting in the regression of ascites. Systemic chemotherapies have minimal effects on PM. The peritoneal cavity acts as a sanctuary against systemic chemotherapy, probably because of the existence of a blood-peritoneal barrier consisting of stromal tissue between mesothelial cells and submesothelial blood capillaries. This barrier acrosses for a total thickness of 90 Î¼m. Accordingly, only a small amount of systemic drugs are capable of penetrating this barrier and passing into the peritoneal cavity. Accordingly, systemic chemotherapy cannot efficiently eradicate peritoneal free cancer cells and established PM. In contrast, peritoneal free cancer cells could be efficiently treated by the intraperitoneal chemotherapy, because high loco-regional intensity can be obtained by the intarperitoneal chemotherapy.
Accordingly, LHIPEC can decrease the PCI levels under the threshold level corresponding with good prognosis, and 2nd laparoscopy can serve as a selection criterion for an evaluation tool of optimal candidates for cytoreductive surgery. After CRS for PM from gastric cancer, the complete cytoreduction is the strongest independent prognostic factor. However, diffuse small bowel involvement is the most frequent cause of the incomplete cytoreduction. This new method is not only a safe method, but also an effective treatment to control malignant ascites and to eradicate peritoneal free cancer cells before CRS. Hyperthermia higher than 41 centigrade is known to increase the drug penetration distance from the peritoneal surface. Laparoscopic HIPEC allows for the better penetration of drugs in peritoneal tumors than HIPEC under laparotomy, because closed HIPEC generates a higher intraperitoneal pressure than HIPEC under laparotomy.
Citation: Yonemura Y, Emel Canbay, Shouzou Sako, Haruaki Ishibashi, Masamitu Hirano Akiyoshi Mizumoto, Kazuyosi Takeshita, Kousuke Noguchi, Nobuyuki Takao, Masumi Ichinose, Yang Liu and Yan Li (2014) Management of Peritoneal Metastases Developed from Gastric Cancer: Laparascopic Hyperthermic Intraperitoneal Chemontherapy in Neoadjuvant Setting. J Integr Oncol 3:117. doi: 10.4172/2329-6771.1000117
Last date updated on July, 2014