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Peritoneal metastases from 
colorectal and gastric cancers 
Glehen olivier 
Surgical Oncology 
Hospices Civils de Lyon 
Centre Hospitalier Lyon Sud
Colorectal 
carcinomatosis
Is There a Possibility of a Cure in Patients With Colorectal 
Peritoneal Carcinomatosis? 
Goere et al. Ann Surg 2012 
107 patients treated with complete 
cytoreductive surgery and 
Intraperitoneal Chemotherapy 
Follow-up for all patients more than 5 
years surgical procedures 
16% of patients were considered cured 
with 5-year or more of disease-free 
interval 
YES
COLORECTAL PC 
Randomized study 
Cytoreductive surgery+ HIPEC (MMC) 
+ 5FU-Leucovorin 
N=48 
 Colorectal PC 
5-FU-Leucovorin 
N=44 
43% (HIPEC) 
 2-year survival 
16% (control roup) 
P=0.001 
Verwaal et al. J Clin Oncol 2003, Ann Surg Oncol 2008
PERITONEAL 
CARCINOMATOSIS 
from COLORECTAL CANCER 
-Elias et al. 
J Clin Oncol 2008 
Retrospective study. 
Cytoreduction with HIPEC 
-48 Cytoreductions + HIPEC (oxaliplatin) versus 
48 « modern » systemic chemotherapy alone 
-Median follow-up  63 months 
-Better results for patients treated with HIPEC 
-51% of 5 year survival vs 13% (p0,05) 
-Median survival of 62 months vs 24 months
PERITONEAL 
CARCINOMATOSIS 
from COLORECTAL CANCER 
-Franko et al. 
Cancer 2010 
Prospective study. 
Cytoreduction with HIPEC 
-67 Cytoreductions + HIPEC versus 38 
« modern » systemic chemotherapy alone 
-Some patients had liver metastasis 
-Better results for patients treated with HIPEC 
-Median survival of 35 months vs 17 months
2012 : Treatment of Peritoneal carcinomatosis : 
When and how to treat ? French national 
recommandations 
 Pseudomyxoma Peritonei. 
 Peritoneal Mesothelioma. 
 PC from colorectal, small 
bowel adenocarcinoma and 
appendiceal cancers. 
Patient in good general status 
When optimal cytoreductive 
surgery (R0 – R1) is achievable. 
Strict patient selection. 
Experienced multidisciplinary 
center. 
 PC from gastric cancer. 
 PC from ovarian cancer. 
PC from pancreas, bile duct, 
gallblader, breast, …. 
Highly recommended 
Under evaluation 
Ongoing trial inclusion 
Probably not ???
COLORECTAL 
CARCINOMATOSIS 
Cytoreductive surgery and 
intraperitoneal chemotherapy 
2222 Registries: national and international 
 500 patients 
1990 - 2007 
75 to 86 % : HIPEC 
54 to 85% de complete cytoreduction 
Mortality: 3 to 4% Morbidity:25 to 30% 
Median survival  30 months 
5 year survival  30% 
J Clin Oncol 2004 and 2010
COLORECTAL 
CARCINOMATOSIS 
2222 Registres: national and international 
Identification of 2 principal 
prognostic factors 
Completeness of cytoreductive 
surgery 
Extent of carcinomatosis 
J Clin Oncol 2004 and 2010 
Cytoreductive surgery and 
intraperitoneal chemotherapy
Colorectal carcinomatosis 
Completeness of cytoreductive surgery 
CC-0 
CC-1 
J Clin Oncol 2010 
CC-2 ou 3 
CC-0
Quantitative tool 
Peritoneal Cancer Index (Sugarbaker) : PCI 
Consensus 
Milan 2006 
PCI from 0 to 39
Colorectal carcinomatosis 
CCCCaaaarrrrcccciiiinnnnoooommmmaaaattttoooossssiiiissss EEEExxxxtttteeeennnntttt 
CC-0
Questions 
Is synchronous liver 
metastasis a 
contraindication for 
curative treatment of 
carcinomatosis?
Survival according to the presence of associated 
Liver Metastases (n= 65) (p= NS)
Colorectal carcinomatosis 
and synchronous liver 
metastasis 
 Liver metastasis does not constitute an 
absolute contraindication for curative 
approach of carcinomatosis 
• Liver metastasis should be controlled by 
systemic chemotherapy 
• Extensive liver surgery combined to 
extensive peritoneal surgery should be 
avoided
Questions 
What about systemic 
chemotherapy?
Improved efficiency of systemic chemotherapy 
for metastatic colorectal cancers 
6 
12 12 
14 
15 
18 18 
21 21 
24 
25 
20 
15 
10 
5 
0 
BSC Bolus 
5FU-LV 
Xeloda LV5FU2 IFL Folfox Folfiri Folfox 
puis IRI 
Folfiri 
puis oxali 
Bevaciz + 
sequentiel 
5FU alone Sequentiel 
treatment 
Combined 
treatment 
Targeted therapy 
Median survival 
(months) 
0 
% 
23 
% 
21 
% 
36- 
59% 
34- 
56% 
60- 
72% 
45- 
72% 
Objective 
response
PC from colorectal origin Palliative systemic 
chemotherapy 
2095 patients 
Median survival 
•Patients with PC : 12.7 months 
•Patients without PC : 17.6 months
French registry colorectal PC 
Multivariate analysis 
Variable p Relative risk 
PCI 0.0001 1.052 
CC-Score 0.05 1.398 
Lymph node + 0.02 1.534 
Adjuvant Chemotherapy 0.002 0.578
SYSTEMIC 
CHEMOTHERAPY 
PERITONEAL 
CARCINOMATOSIS 
from COLORECTAL CANCER 
Peritoneal carcinomatosis has a different natural 
history and response to systemic chemotherapy than 
liver or lung metastasis 
BUT 
50 to 75% of patient with peritoneal 
carcinomatosis will develop extra-peritoneal 
disease 
Role of adjuvant systemic chemotherapy into registries 
Systemic chemotherapy should be considered 
as one important tool in the multidisciplinary 
management of PC
Unresolved Questions 
Systemic chemotherapy 
should be used before, 
after, both ?
P = 0.042 
Ann Surg 2012 
120 patients
Patients with progressive but resectable disease 
had median survival more than 30 months 
P = NS 
Ann Surg 2012
Colorectal carcinomatosis and 
neoadjuvant chemotherapy 
 Progression with neoadjuvant systemic 
chemotherapy does not constitute an 
absolute contraindication for curative 
approach of carcinomatosis 
• Median survival more of 30 months may be 
obtained 
 The use of neoadjuvant systemic 
chemotherapy is important to exclude 
patients who will develop extraperitoneal 
disease 
Ann Surg 2012
Unresolved Questions 
What is the exact role of 
HIPEC into therapeutic 
management ?
There was not significant difference 
between: 
 Median OS ox alone 41 months, 
(95%CI 29–61) 
 Median OS ox-iri 47 months, (95%CI 
32-61) 
(p=0.94) 
What is the specific role of HIPEC ?
PRODIGE 7 (F Quenet) 
RANDOMIZED FRENCH STUDY 
Colorectal carcinomatosis 
Complete cytoreductive 
No HIPEC 
surgery 
RANDOMIZATION 
HIPEC oxaliplatin 
Perioperative systemic 
chemotherapy for 6 months 
RANDOMIZATION
Prevention 
Interest of 2nd look for 
patients at risk of 
carcinomatosis 
development?
From 1999 to 2009, 47 patients with a high risk to develop a PC 
(without clinical, radiologic or biologic symptoms), underwent a 
second look, 12 months after their first surgery. 
 Selected: 3 groups of high-risk patients: 
• Minimal macroscopic PC completely resected 
• Ovarian metastases, 
• Perforation of primary tumour. 
 All these patients received the adjuvant standard treatment after the 
first surgery: 6 months of systemic chemotherapy (Folfox or Folfiri) 
50% of patients had carcinomatosis 
HIPEC was an the only independant 
prognostic factor
French randomized multicentric study 
(Prophylochip) 
Patients at risk of carcinomatosis 
development 
(Perforated tumors, localized carcinomatosis 
removed, isolated ovarian metastasis) 
Adjuvant FOLFOX (6 months) 
or systemic chemotherapy 
(Negative workshop) 
Randomization 8 months 
Follow-up 
2nd look and 
prophylactic HIPEC
Gastric 
carcinomatosis 
Results
Overall survival according to etiology 
Cancer 2010
Feb. 1989 – Aug. 2007 
 159 patients 
 15 centers 
 M: 83 F: 76 
 Mean age 53,4 ± 12,8 
 PC Synchronous : 44% 
 PC Metachronous : 66%
Gastric carcinomatosis AFC 
Intraperitoneal chemotherapy 
 HIPEC : 154 cases (94%) 
• Closed abdomen : 
142 cases (54%) 
• Open abdomen : 46% 
 EPIC : 12 cases (7,5%) 
 Mitomycin C : 83%
Gastric carcinomatosis AFC 
Mortality-Morbidity 
 Mortality: 10 cases (6,5%) 
 Morbidity grade 3-4: 38 cases 
(27,8%) 
• Digestive fistula : 16% 
• Reoperation: 14% 
• Mean post-operative stay : 
24,2±19 days 
1344 procedures 
 Mortality : 4,1% 
 Morbidity gr. 3-4: 
33,8% 
• Dig. fistula : 9,6% 
• Reoperation: 14% 
• Mean post-operative 
stay : 
24,1±18 days
Gastric carcinomatosis 
Prognostic factors 
Institutions 
P0,001
Gastric carcinomatosis 
Prognostic factors 
Treatment with neoadjuvant systemic 
chemotherapy 
P=0,018
Gastric carcinomatosis 
Prognostic factors 
Completeness of cytoreductive surgery 
Patients CC-0: 
•Median 15 months 
•5 year 
survival:25% 
Patients CC-2 or 3 
•Median 4 months 
•2 years 
survival:0% 
P0,001
Gastric carcinomatosis 
Prognostic factors 
Influence of disease extension in patients 
treated by complete cytoreductive surgery 
No patient alive at 
2 years for PCI  
13 
No patient alive at 
1 year for PCI  19 
P=0,038
PHASE III STUDY in Gastric Cancer 
Yang et al. Ann Surg Oncol 2011 
Gastric Carcinomatosis 
Cytoreductive 
surgery 
RANDOMISATION 
Cytoreductive surgery 
+ HIPEC with CDDP 
and MMC 
Systemic chemotherapy ?? 
Perioperative or adjuvant?? 
RANDOMISATION
PHASE III STUDY in Gastric Cancer 
Yang et al. Ann Surg Oncol 2011 
HIPEC did not improve mortality and 
morbidity rates
PHASE III STUDY in Gastric Cancer 
Yang et al. Ann Surg Oncol 2011 
HIPEC improved survival (p=0.046) 
Synchronous PC++
Conclusions 
 Cytoreductive surgery and HIPEC are the only 
way to obtain long-term survivors 
 5-year survival rates of 20% may be obtained 
into expert centers 
 Strict selection necessary
Conclusions 
 Which patients? 
• Patients with perfect general status ( 70 
years) 
High Mortality et Morbidity rates 
Quality of life ++++ 
• Complete cytoreductive surgery 
Strongest prognotic factor 
• Limited PC (PCI  19 ou 12) 
LIMITED NUMBER OF PATIENTS
Conclusions 
 How to improve selection? 
• Neoadjuvant systemic chemotherapy 
 Gold standard in Europe 
 Exclusion of patients with metastatic progression 
• Neoadjuvant intraperitoneal chemotherapy
Neoadjuvant intraperitoneal systemic 
chemotherapy (NIPS) Yonemura
Neoadjuvant intraperitoneal systemic 
chemotherapy (NIPS) Yonemura 
Increases the rate complete cytoreductive surgery by increasing downstaging 
Phase I-II in Europe
Conclusions 
 How to improve 
selection? 
• Laparoscopy as soon as 
possible +++++ 
 Exclusion of patients diffuse 
disease 
 Diagnosis of limited PC
Gastric cancers and preventive 
management 
 Recurrences following curative 
treatment 
Recurrences  50% 
• 1/3 of peritoneal carcinomatosis 
• 1/3 of locoregional recurrence 
CANCER that HAVE THE MOST IMPORTANT 
RATE of LOCOREGIONAL RELAPSE 
Yoo Br J Surg 2000
Peritoneal recurrence and 
gastric cancer 
 Factors associated with peritoneal 
recurrence 
• Linitis or poorly differentiated tumors 
(independant cancer cells) 
• Lymph node involvement 
• Serosal involvement 
• Positive cytology+++ 
Maehara Br J surg 2000 
Ceelen Br J Surg 2000 
Bonenkamp N Engl J Med 1999 
Honore Eur J Surg Oncol 2013
Meta-analysis of postoperative intraperitoneal 
chemotherapy in gastric cancer 
Yan et al Ann Sug Oncol 2007
GASTRICHIP (PHRC 2012) 
Randomized multicentric phase III 
Gastric adenocarcinoma T3-T4 and/or 
N+ and/or cyto + (laparoscopy and ultrasound 
Peroperative systemic 
chemotherapy recommended 
Curative gastrectomy 
Peroperative 
RANDOMIZATION 
endoscopy) 
Curative gastrectomy + 
HIPEC oxaliplatin 
Postoperative adjuvant treatment 
Peroperative 
RANDOMIZATION 
Indication of curative gastrectomy 
Inform consent
Take Home Messages 
•Cytoreduction and HIPEC should be considered for many colorectal 
PC and some gastric PC 
•The 2 most important prognostic factors are 
COMPLETENESS OF CYTOREDUCTIVE SURGERY 
PCI 
•Multidisciplinary management including systemic chemotherapy is 
very important and should be more evaluated 
•HIPEC for prevention and prophylactic approach should be 
considered

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O. Glehen - HIPEC Colorectal and Gastric

  • 1. Peritoneal metastases from colorectal and gastric cancers Glehen olivier Surgical Oncology Hospices Civils de Lyon Centre Hospitalier Lyon Sud
  • 3. Is There a Possibility of a Cure in Patients With Colorectal Peritoneal Carcinomatosis? Goere et al. Ann Surg 2012 107 patients treated with complete cytoreductive surgery and Intraperitoneal Chemotherapy Follow-up for all patients more than 5 years surgical procedures 16% of patients were considered cured with 5-year or more of disease-free interval YES
  • 4. COLORECTAL PC Randomized study Cytoreductive surgery+ HIPEC (MMC) + 5FU-Leucovorin N=48 Colorectal PC 5-FU-Leucovorin N=44 43% (HIPEC) 2-year survival 16% (control roup) P=0.001 Verwaal et al. J Clin Oncol 2003, Ann Surg Oncol 2008
  • 5. PERITONEAL CARCINOMATOSIS from COLORECTAL CANCER -Elias et al. J Clin Oncol 2008 Retrospective study. Cytoreduction with HIPEC -48 Cytoreductions + HIPEC (oxaliplatin) versus 48 « modern » systemic chemotherapy alone -Median follow-up 63 months -Better results for patients treated with HIPEC -51% of 5 year survival vs 13% (p0,05) -Median survival of 62 months vs 24 months
  • 6. PERITONEAL CARCINOMATOSIS from COLORECTAL CANCER -Franko et al. Cancer 2010 Prospective study. Cytoreduction with HIPEC -67 Cytoreductions + HIPEC versus 38 « modern » systemic chemotherapy alone -Some patients had liver metastasis -Better results for patients treated with HIPEC -Median survival of 35 months vs 17 months
  • 7. 2012 : Treatment of Peritoneal carcinomatosis : When and how to treat ? French national recommandations Pseudomyxoma Peritonei. Peritoneal Mesothelioma. PC from colorectal, small bowel adenocarcinoma and appendiceal cancers. Patient in good general status When optimal cytoreductive surgery (R0 – R1) is achievable. Strict patient selection. Experienced multidisciplinary center. PC from gastric cancer. PC from ovarian cancer. PC from pancreas, bile duct, gallblader, breast, …. Highly recommended Under evaluation Ongoing trial inclusion Probably not ???
  • 8. COLORECTAL CARCINOMATOSIS Cytoreductive surgery and intraperitoneal chemotherapy 2222 Registries: national and international 500 patients 1990 - 2007 75 to 86 % : HIPEC 54 to 85% de complete cytoreduction Mortality: 3 to 4% Morbidity:25 to 30% Median survival 30 months 5 year survival 30% J Clin Oncol 2004 and 2010
  • 9. COLORECTAL CARCINOMATOSIS 2222 Registres: national and international Identification of 2 principal prognostic factors Completeness of cytoreductive surgery Extent of carcinomatosis J Clin Oncol 2004 and 2010 Cytoreductive surgery and intraperitoneal chemotherapy
  • 10. Colorectal carcinomatosis Completeness of cytoreductive surgery CC-0 CC-1 J Clin Oncol 2010 CC-2 ou 3 CC-0
  • 11. Quantitative tool Peritoneal Cancer Index (Sugarbaker) : PCI Consensus Milan 2006 PCI from 0 to 39
  • 13. Questions Is synchronous liver metastasis a contraindication for curative treatment of carcinomatosis?
  • 14. Survival according to the presence of associated Liver Metastases (n= 65) (p= NS)
  • 15. Colorectal carcinomatosis and synchronous liver metastasis Liver metastasis does not constitute an absolute contraindication for curative approach of carcinomatosis • Liver metastasis should be controlled by systemic chemotherapy • Extensive liver surgery combined to extensive peritoneal surgery should be avoided
  • 16. Questions What about systemic chemotherapy?
  • 17. Improved efficiency of systemic chemotherapy for metastatic colorectal cancers 6 12 12 14 15 18 18 21 21 24 25 20 15 10 5 0 BSC Bolus 5FU-LV Xeloda LV5FU2 IFL Folfox Folfiri Folfox puis IRI Folfiri puis oxali Bevaciz + sequentiel 5FU alone Sequentiel treatment Combined treatment Targeted therapy Median survival (months) 0 % 23 % 21 % 36- 59% 34- 56% 60- 72% 45- 72% Objective response
  • 18. PC from colorectal origin Palliative systemic chemotherapy 2095 patients Median survival •Patients with PC : 12.7 months •Patients without PC : 17.6 months
  • 19. French registry colorectal PC Multivariate analysis Variable p Relative risk PCI 0.0001 1.052 CC-Score 0.05 1.398 Lymph node + 0.02 1.534 Adjuvant Chemotherapy 0.002 0.578
  • 20. SYSTEMIC CHEMOTHERAPY PERITONEAL CARCINOMATOSIS from COLORECTAL CANCER Peritoneal carcinomatosis has a different natural history and response to systemic chemotherapy than liver or lung metastasis BUT 50 to 75% of patient with peritoneal carcinomatosis will develop extra-peritoneal disease Role of adjuvant systemic chemotherapy into registries Systemic chemotherapy should be considered as one important tool in the multidisciplinary management of PC
  • 21. Unresolved Questions Systemic chemotherapy should be used before, after, both ?
  • 22. P = 0.042 Ann Surg 2012 120 patients
  • 23. Patients with progressive but resectable disease had median survival more than 30 months P = NS Ann Surg 2012
  • 24. Colorectal carcinomatosis and neoadjuvant chemotherapy Progression with neoadjuvant systemic chemotherapy does not constitute an absolute contraindication for curative approach of carcinomatosis • Median survival more of 30 months may be obtained The use of neoadjuvant systemic chemotherapy is important to exclude patients who will develop extraperitoneal disease Ann Surg 2012
  • 25. Unresolved Questions What is the exact role of HIPEC into therapeutic management ?
  • 26. There was not significant difference between: Median OS ox alone 41 months, (95%CI 29–61) Median OS ox-iri 47 months, (95%CI 32-61) (p=0.94) What is the specific role of HIPEC ?
  • 27. PRODIGE 7 (F Quenet) RANDOMIZED FRENCH STUDY Colorectal carcinomatosis Complete cytoreductive No HIPEC surgery RANDOMIZATION HIPEC oxaliplatin Perioperative systemic chemotherapy for 6 months RANDOMIZATION
  • 28. Prevention Interest of 2nd look for patients at risk of carcinomatosis development?
  • 29. From 1999 to 2009, 47 patients with a high risk to develop a PC (without clinical, radiologic or biologic symptoms), underwent a second look, 12 months after their first surgery. Selected: 3 groups of high-risk patients: • Minimal macroscopic PC completely resected • Ovarian metastases, • Perforation of primary tumour. All these patients received the adjuvant standard treatment after the first surgery: 6 months of systemic chemotherapy (Folfox or Folfiri) 50% of patients had carcinomatosis HIPEC was an the only independant prognostic factor
  • 30. French randomized multicentric study (Prophylochip) Patients at risk of carcinomatosis development (Perforated tumors, localized carcinomatosis removed, isolated ovarian metastasis) Adjuvant FOLFOX (6 months) or systemic chemotherapy (Negative workshop) Randomization 8 months Follow-up 2nd look and prophylactic HIPEC
  • 32. Overall survival according to etiology Cancer 2010
  • 33. Feb. 1989 – Aug. 2007 159 patients 15 centers M: 83 F: 76 Mean age 53,4 ± 12,8 PC Synchronous : 44% PC Metachronous : 66%
  • 34. Gastric carcinomatosis AFC Intraperitoneal chemotherapy HIPEC : 154 cases (94%) • Closed abdomen : 142 cases (54%) • Open abdomen : 46% EPIC : 12 cases (7,5%) Mitomycin C : 83%
  • 35. Gastric carcinomatosis AFC Mortality-Morbidity Mortality: 10 cases (6,5%) Morbidity grade 3-4: 38 cases (27,8%) • Digestive fistula : 16% • Reoperation: 14% • Mean post-operative stay : 24,2±19 days 1344 procedures Mortality : 4,1% Morbidity gr. 3-4: 33,8% • Dig. fistula : 9,6% • Reoperation: 14% • Mean post-operative stay : 24,1±18 days
  • 36. Gastric carcinomatosis Prognostic factors Institutions P0,001
  • 37. Gastric carcinomatosis Prognostic factors Treatment with neoadjuvant systemic chemotherapy P=0,018
  • 38. Gastric carcinomatosis Prognostic factors Completeness of cytoreductive surgery Patients CC-0: •Median 15 months •5 year survival:25% Patients CC-2 or 3 •Median 4 months •2 years survival:0% P0,001
  • 39. Gastric carcinomatosis Prognostic factors Influence of disease extension in patients treated by complete cytoreductive surgery No patient alive at 2 years for PCI 13 No patient alive at 1 year for PCI 19 P=0,038
  • 40. PHASE III STUDY in Gastric Cancer Yang et al. Ann Surg Oncol 2011 Gastric Carcinomatosis Cytoreductive surgery RANDOMISATION Cytoreductive surgery + HIPEC with CDDP and MMC Systemic chemotherapy ?? Perioperative or adjuvant?? RANDOMISATION
  • 41. PHASE III STUDY in Gastric Cancer Yang et al. Ann Surg Oncol 2011 HIPEC did not improve mortality and morbidity rates
  • 42. PHASE III STUDY in Gastric Cancer Yang et al. Ann Surg Oncol 2011 HIPEC improved survival (p=0.046) Synchronous PC++
  • 43. Conclusions Cytoreductive surgery and HIPEC are the only way to obtain long-term survivors 5-year survival rates of 20% may be obtained into expert centers Strict selection necessary
  • 44. Conclusions Which patients? • Patients with perfect general status ( 70 years) High Mortality et Morbidity rates Quality of life ++++ • Complete cytoreductive surgery Strongest prognotic factor • Limited PC (PCI 19 ou 12) LIMITED NUMBER OF PATIENTS
  • 45. Conclusions How to improve selection? • Neoadjuvant systemic chemotherapy Gold standard in Europe Exclusion of patients with metastatic progression • Neoadjuvant intraperitoneal chemotherapy
  • 46. Neoadjuvant intraperitoneal systemic chemotherapy (NIPS) Yonemura
  • 47. Neoadjuvant intraperitoneal systemic chemotherapy (NIPS) Yonemura Increases the rate complete cytoreductive surgery by increasing downstaging Phase I-II in Europe
  • 48. Conclusions How to improve selection? • Laparoscopy as soon as possible +++++ Exclusion of patients diffuse disease Diagnosis of limited PC
  • 49. Gastric cancers and preventive management Recurrences following curative treatment Recurrences 50% • 1/3 of peritoneal carcinomatosis • 1/3 of locoregional recurrence CANCER that HAVE THE MOST IMPORTANT RATE of LOCOREGIONAL RELAPSE Yoo Br J Surg 2000
  • 50. Peritoneal recurrence and gastric cancer Factors associated with peritoneal recurrence • Linitis or poorly differentiated tumors (independant cancer cells) • Lymph node involvement • Serosal involvement • Positive cytology+++ Maehara Br J surg 2000 Ceelen Br J Surg 2000 Bonenkamp N Engl J Med 1999 Honore Eur J Surg Oncol 2013
  • 51. Meta-analysis of postoperative intraperitoneal chemotherapy in gastric cancer Yan et al Ann Sug Oncol 2007
  • 52. GASTRICHIP (PHRC 2012) Randomized multicentric phase III Gastric adenocarcinoma T3-T4 and/or N+ and/or cyto + (laparoscopy and ultrasound Peroperative systemic chemotherapy recommended Curative gastrectomy Peroperative RANDOMIZATION endoscopy) Curative gastrectomy + HIPEC oxaliplatin Postoperative adjuvant treatment Peroperative RANDOMIZATION Indication of curative gastrectomy Inform consent
  • 53. Take Home Messages •Cytoreduction and HIPEC should be considered for many colorectal PC and some gastric PC •The 2 most important prognostic factors are COMPLETENESS OF CYTOREDUCTIVE SURGERY PCI •Multidisciplinary management including systemic chemotherapy is very important and should be more evaluated •HIPEC for prevention and prophylactic approach should be considered