Good Doctor·Hyperthermic Perfusion | Literature Review and Analysis | (4) “Clinical Application of Early Postoperative Intraperitoneal Hyperthermic Perfusion Chemotherapy for Gastric Cancer”

[Abstract]

Hyperthermic perfusion therapy equipment: TRL-type thermochemotherapy perfusion machine (produced by Harbin Aerospace Science and Technology Development Co., Ltd., the predecessor of Xi’an Good Doctor Medical Science and Technology Co., Ltd.).

Methods: A total of 96 patients who underwent radical gastrectomy for gastric cancer were randomly assigned to an observation group and a control group using a random number table. The observation group (n=48) received early postoperative intraperitoneal hyperthermic chemotherapy combined with intravenous chemotherapy, while the control group (n=48) received only postoperative intravenous chemotherapy. Adverse reactions and complications, quality of life, immune function, local recurrence rate, distant metastasis rate, and overall survival were compared between the two groups.

Results: There was no statistically significant difference between the two groups in postoperative adverse reactions or complications (P > 0.05); quality-of-life improvement was greater in the observation group than in the control group (P < 0.05); levels of CD3+, CD4+, and the CD4+/CD8+ ratio were significantly higher in the observation group compared with baseline (P < 0.01), whereas no significant changes were observed in the control group; the local recurrence rate in the abdominal cavity was significantly lower in the observation group than in the control group (P < 0.05).

Conclusion: Early postoperative intraperitoneal hyperthermic chemotherapy combined with intravenous chemotherapy in patients with gastric cancer can improve quality of life, enhance cellular immune function, and reduce the rate of local metastasis and recurrence. Moreover, the adverse reactions are tolerable, and there is no significant increase in the incidence of complications, suggesting that this approach warrants further clinical investigation with larger sample sizes.

丨Article丨Source丨Core丨Background丨

“Clinical Application of Early Intraperitoneal Hyperthermic Perfusion Chemotherapy After Gastric Cancer Surgery” – Jilin Medical Journal, Volume 33, Issue 8 (Huang Yiwei, Xu Haifan, Lu Feng, Zheng Di)

Objective: To evaluate the clinical efficacy of early intraperitoneal hyperthermic perfusion chemotherapy following radical gastrectomy for gastric cancer.

[Keywords] Gastric cancer; hyperthermic intraperitoneal chemotherapy; chemotherapy; quality of life; immune function

丨Expert丨Analysis丨

This study focused on patients who had undergone radical gastrectomy for gastric cancer, comparing two treatment regimens: intraperitoneal hyperthermic perfusion chemotherapy combined with intravenous chemotherapy versus intravenous chemotherapy alone. The primary outcomes of interest included adverse events, immune status, tumor recurrence and metastasis, quality of life, and short-term survival. By addressing the clinical challenges of high rates of peritoneal metastasis, poor local control, and frequent recurrence following radical gastrectomy, this research aligns closely with real-world clinical needs.

Characteristics/Advantages of This Study

Outstanding value exploration

This clinical study was conducted from 2010 to 2011, and the paper was officially published in 2012. At that time, hyperthermic intraperitoneal chemotherapy (HIPEC) in China was still in its exploratory phase, with no standardized operating protocols or high-quality comparative studies available. The research team was among the first to introduce intraoperative hyperthermic perfusion early after radical gastrectomy, designing the trial in accordance with cutting-edge international literature. This pioneering work represented one of the earliest clinical investigations in this field in China, providing foundational data that facilitated the subsequent dissemination of the technique and the development of standardized guidelines.

The experimental design is reasonable.

The study enrolled a total of 96 patients who underwent radical gastrectomy, randomly assigned to an observation group and a control group, with 48 patients in each group. The two groups were broadly comparable in baseline characteristics, including age, sex, pathological subtype, tumor stage, and surgical approach, providing a robust basis for comparison. In this clinical trial, only the observation group received early postoperative HIPEC; all other intravenous chemotherapy regimens were identical between the two groups, ensuring clear control of confounding variables and enabling an accurate assessment of the treatment differences attributable to HIPEC. The overall study design closely mirrors real-world clinical practice.

Comprehensive evaluation dimensions

In addition to routine statistical analyses of adverse events, tumor recurrence and metastasis rates, and short-term survival, the study specifically assessed T‑cell subsets (CD3+, CD4+, and the CD4+/CD8+ ratio) to evaluate patients’ immune function, and employed the KPS score to quantify quality of life. Throughout the treatment course, no severe complications—such as anastomotic leakage, intra-abdominal infection, or chemical peritonitis—were observed, thereby confirming both the therapeutic efficacy and the safety and reliability of early HIPEC following radical gastrectomy for gastric cancer, while also demonstrating that HIPEC can enhance patients’ T‑cell–mediated immune responses.

Early postoperative administration of HIPEC offers clear advantages.

At this stage, the tumor burden in the body is at its lowest, cancer cell proliferation is vigorous and highly responsive to chemotherapy; surgical wounds and the peritoneal surface have not yet developed adhesions, allowing the perfusate to achieve thorough contact with all peritoneal surfaces and ensuring uniform distribution of temperature and drug concentration. Large‑volume, sub‑hyperthermic solutions containing chemotherapeutic agents not only mechanically flush away free cancer cells but also maintain a high, sustained drug concentration within the abdominal cavity, while minimizing systemic exposure and associated adverse effects. Consequently, hyperthermic intraperitoneal chemotherapy (HIPEC) offers distinct clinical advantages over conventional intraperitoneal chemotherapy alone. Its therapeutic efficacy hinges on the synergistic sensitization effects of hyperthermia and thermochemotherapy, combined with mechanical flushing—collectively forming the foundation for treatment success. High‑precision infusion devices capable of precisely controlling temperature and flow rate provide robust technical support for achieving these goals. The high‑precision temperature‑controlled perfusion system employed in this study represents an ideal technological platform for delivering stable, safe, and efficient HIPEC.

Overall Evaluation

This study was conducted during the exploratory and developmental phase of HIPEC technology in China from 2010 to 2011. A total of 96 patients who had undergone surgery for gastric cancer were prospectively enrolled and randomly assigned to either a HIPEC plus intravenous chemotherapy group (the observation group) or an intravenous chemotherapy–only group (the control group). Systematic comparative assessments were performed across multiple domains, including adverse events, immune function, quality of life, recurrence rates, and survival outcomes. The results demonstrated that early postoperative HIPEC combined with intravenous chemotherapy can improve patients’ quality of life, enhance cellular immune function, and reduce the rate of local metastasis and recurrence. Moreover, the treatment was well tolerated, with no significant increase in the incidence of complications, suggesting that further clinical studies with larger sample sizes are warranted. These findings not only establish the clinical foundation for the use of HIPEC as an adjuvant therapy following radical gastrectomy but also provide practical, actionable guidance for optimizing treatment parameters, developing clinical guidelines, and enabling grassroots medical institutions to implement this modality.

Expert Profile

Dr. Liu, M.D., Ph.D.

Professional Society Member:

• American Society for Cell Biology (2006–present)

• American Heart Association (2006–present)

• American Thoracic Society (1997–present)

• 2023–2025.5 Associate Professor, Department of Cardiology, University of Miami, USA

• 1999–2023 Assistant/Associate Professor, Division of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, USA

• 1996–1999 Postdoctoral Fellow, Department of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, USA

• 1992–1995: Master of Medicine, Department of Respiratory Medicine, Xijing Hospital, Fourth Military Medical University (under Professor Sun Bin)

• 1986–1992: Clinical Physician, Department of Respiratory Medicine, General Hospital of the Shenyang Military Region

• 1981–1986 Bachelor of Medicine, Department of Clinical Medicine, Fourth Military Medical University