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Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer Wansik Yu, MD, FACS Kyungpook National University Taegu, Korea.

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Presentation on theme: "Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer Wansik Yu, MD, FACS Kyungpook National University Taegu, Korea."— Presentation transcript:

1 Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer Wansik Yu, MD, FACS Kyungpook National University Taegu, Korea

2 Mechanism of Dissemination Detachment of cancer cells Movement through the peritoneal cavity Attachment to the peritoneum Invasion into the subperitoneal tissue Proliferation

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5 Management Surgery Left upper abdominal evisceration Peritonectomy Chemotherapy Systemic chemotherapy Intra-arterial chemotherapy Intraperitoneal chemotherapy

6 Heat Diseases that medicines do not cure are cured by the knife. Those that the knife does not cure are cured by fire. Those that fire does not cure must be considered incurable. Hippocrates

7 Principles of Hyperthermia Direct cytocidal effect by hyperthermia degeneration of protein impairment of nucleic acid synthesis chromosomal damage Vascular bed thrombosis occlusion

8 Augmentation of Cytotoxicity Hypoxia Low pH Hypoglycemia Radiation Ethanol Some anticancer drugs Increased permeability

9 ChemoThermo-Sensitivity* Normothermia Hyperthermia** CDDP5%32% VP-160%31% MMC6%38% ADM0% 8% * MTT assay with 21 gastric cancers ** 43  C for 1 hour

10 Methods of Hyperthermia Systemic hyperthermia Regional perfusion hyperthermia Radiofrequency capacitive hyperthermia Intracavitary hyperthermic perfusion

11 Hyperthermic IP Chemotherapy Postoperative (closed method) Intraoperative (open method) after reconstruction peritoneal cavity expander before reconstruction coliseum technique manual stirring

12 Closed (Postoperative) Method drugs thermistor 44~45  C pump 40~42  C 48~50  C water bath

13 Peritoneal Cavity Expander filter drugs Peritoneal cavity expander pump Heat exchanger 43  C 42  C

14 Coliseum Technique Chemotherapy reservoir 2. In-flow pump 3. Out-flow pump 4. Heat exchanger 5. Temperature probe 6. Thermometer 7. Temperature probes 8. Smoke evacuator 9. Thompson retractor

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16 General Management Control of intraperitoneal cavity temperature monitoring Replacement of serum protein fresh frozen plasma / human albumin Prevention of pulmonary edema hemodynamic monitoring dopamin / furosemide

17 Clinical Experience ABC Effect32%90%* Therapeutic # 16%no effect47% Prophylactic † 52%:32% ‡ 63%:43% ‡ A; Kanazawa, B; Tottori, C; Lyon *Ascites control # 2-year survival rate, † 5-year survival rate ‡ P<0.05

18 Survival Distribution years % HIC(-) (n=21) HIC(+) (n=33) (With macroscopical residual disease)

19 HIC(+) (n=17) HIC(-) (n=13) % years Survival Distribution (After complete cytoreduction)

20 Peritonectomy systematic peritoneal stripping Indication limited number of metastatic nodules on the peritoneum without other distant metastasis

21 vessel mesothelial cells fibroblast cancer cells drugs fibrosis muscle Peritonectomy Heat Peritoneal cavity Drug

22 Complications A B C D Leakage3% 5% 4% 0% BM suppression9% 0% 0% 6% Renal failure6% 0% 0% 0% Perforation2% 5% 0% 6% A; Kanazawa, B; Tottori, C; Lyon, D; Taegu

23 Mean Temperatures CC

24 Problems To Be Solved Even distribution of heat Even distribution of drug Morbidity and mortality Drug combination Safety considerations Cost (equipments)

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26 Treatment of AGC Resection + Systematic lymphadenectomy + Perioperative IP Chemotherapy (IO/with or without heat, EP) + Peritonectomy + Systemic chemotherapy (?)

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28 謝謝 감사합니다. Thank you very much.


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