NIPS Trial


  • Can neoadjuvant intraperitoneal systemic chemotherapy (NIPS) help surgeons remove more cancer cells during a gastrectomy? NIPS is a chemotherapy method which gives drugs directly to the peritoneum for a few weeks before surgery. This is done using a catheter tube. In this experiment, some patients had NIPS before gastrectomy. The researchers found that these patients had fewer cancer cells remaining in their belly after the surgery. So, NIPS can be helpful before surgery to more completely remove cancer cells.



  • Japan


  • Published 2012, International Journal of Surgical Oncology

Impact Factor (IF):

  • 0.580

Gastric cancer cells can spread to nearby structures. The spread of cancer cells is called metastasis. When metastasis to the peritoneum happens, patients develop peritoneal carcinomatosis (PC).

A gastrectomy can cut out the solid tumor from the stomach, but it can be hard to remove all of the cancer cells from the belly. Chemotherapy given around the time of surgery can kill cancer cells and stop the disease from spreading. Neoadjuvant Intraperitoneal Systemic Chemotherapy (NIPS) is one way of giving chemotherapy right before surgery. NIPS passes fluid with chemotherapy medications through the peritoneum. The medications are given through a tube called a catheter. NIPS shrinks and weakens the tumor. This way, it is easier for the surgeon to cut the whole thing out.

This study wanted to know if NIPS before surgery can help gastric cancer patients whose disease had spread to their peritoneum. 82 patients had two cycles of NIPS before surgery. The chemotherapy treatment included:

  • S-1: stops cancer cells from dividing properly. This was given as a pill for 3 weeks before surgery.
  • Cisplatin (CDDP/CF): this drug stops cancer from making more cells.
  • Taxotere: is another name for docetaxel, which disrupts the cell’s internal support system, so it cannot divide properly.

Most patients had a total gastrectomy surgery. The researchers compared the results of applying NIPS to systemic chemotherapy only. Systemic chemotherapy means that the drugs are spread throughout the whole body in the blood. NIPS delivers the chemotherapy right to the peritoneum.

The researchers looked at many factors to decide if their treatment was helpful. For example, cytology involves looking at samples of cells to see if they have cancer or not. They found that NIPS significantly decreased the number of cells with cancer. Before NIPS, 70.8% of patients had cancer cells which had spread from the tumor to the peritoneum. After NIPS, only 22.9% of patients still had cancer cells in the peritoneum.

So, this experiment showed that having NIPS chemotherapy before gastric resection surgery can be helpful in getting rid of more cancer cells. This treatment is best used in certain patients and only when the surgeon has had practice in the CRS techniques.

Related Readings:

    • Fujiwara, Yoshiyuki, et al. “Neoadjuvant intraperitoneal and systemic chemotherapy for gastric cancer patients with peritoneal dissemination.” Annals of surgical oncology 18.13 (2011): 3726-3731. Available from: doi: 10.1245/s10434-011-1770-8
    • This study looked at how useful giving NIPS to patients with advanced gastric cancer could be. They studied 25 patients with advanced gastric cancer which had spread to the peritoneum. The patients were first given NIPS chemotherapy. Next, they were given standard intravenous chemotherapy (systemic chemotherapy). Finally, they had a gastrectomy. The researchers found that this combination was helpful in these patients.


  • Yutaka Yonemura, Ayman Elnemr, Yoshio Endou, et al., “Effects of Neoadjuvant Intraperitoneal/Systemic Chemotherapy (Bidirectional Chemotherapy) for the Treatment of Patients with Peritoneal Metastasis from Gastric Cancer,” International Journal of Surgical Oncology, vol. 2012, Article ID 148420, 8 pages, 2012. Available from: doi: