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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2023; 15(3): 430-439
Published online Mar 27, 2023. doi: 10.4240/wjgs.v15.i3.430
Efficacy and outcome of extensive intraoperative peritoneal lavage plus surgery vs surgery alone with advanced gastric cancer patients
En-Dong Song, Heng-Bo Xia, Li-Xiang Zhang, Jun Ma, Pan-Quan Luo, Lai-Zhi Yang, Ben-Hong Xiang, Bai-Chuan Zhou, Lei Chen, Hui Sheng, Yin Fang, Wen-Xiu Han, Zhi-Jian Wei, A-Man Xu
En-Dong Song, Lai-Zhi Yang, Ben-Hong Xiang, Yin Fang, Department of General Surgery, The First People’s Hospital of Wuhu City, Wuhu 241000, Anhui Province, China
Heng-Bo Xia, Li-Xiang Zhang, Pan-Quan Luo, Bai-Chuan Zhou, Wen-Xiu Han, Zhi-Jian Wei, A-Man Xu, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, Anhui Province, China
Jun Ma, Department of Surgical Oncology, Anqing Municipal Hospital, Anqing 246000, Anhui Province, China
Lei Chen, Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Hui Sheng, Department of Obstetrics and Gynecology, East Hospital Area of Wuhan Fourth Hospital, Wuhan 430030, Hubei Province, China
Author contributions: Song ED, Xia HB, Zhang LX, Ma J, Luo QP, Yang LZ and Xiang BH wrote the manuscript and revised the main work, and they contributed equally to this work and share the first authorship; Sheng Hui, Fang Y, Han WX, Wei ZJ and Xu AM designed this study, and they are all the correspondence and contributed equally to this work; Zhou BC and Chen L were responsible for the production of pictures; All authors contributed to the article and approved the submitted version.
Institutional review board statement: This study was approved by the institutional review board of The First Affiliated Hospital of Anhui Medical University, No. 2108085QH337.
Clinical trial registration statement: This study was registered at ClinicalTrials.gov, identification number: NCT02745509.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors state that they have no conflicts of interest to declare.
Data sharing statement: The data can be obtained from the correspondence.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: A-Man Xu, MD, Doctor, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Ji-Xi Road, Hefei 230032, Anhui Province, China. xuaman@ahmu.edu.cn
Received: November 26, 2022
Peer-review started: November 26, 2022
First decision: January 3, 2023
Revised: January 15, 2023
Accepted: February 22, 2023
Article in press: February 22, 2023
Published online: March 27, 2023
ARTICLE HIGHLIGHTS
Research background
After resection, one of the major problems is the peritoneal dissemination and recurrence of gastric cancer (GC). It is necessary to remove residual tumor cells. Recently, a study found that extensive intraoperative peritoneal lavage (EIPL) plus intraperitoneal chemotherapy can improve the prognosis of patients and eradicate peritoneal free cancer for GC patients.
Research motivation
The efficacy and outcome of advanced GC patients treated with EIPL has not been determined.
Research objectives
Evaluating the efficacy and long-term outcome of advanced GC patients treated with EIPL.
Research methods
A total of 150 patients with advanced GC were enrolled in this study according to the inclusion and exclusion criteria and randomly allocated to 2 groups. For the non-EIPL group, peritoneal lavage was performed using no more than 3 L of warm saline. In the EIPL group, patients received 10 L or more of saline (1 L at a time) before the closure of the abdomen. The surviving rate analysis was compared by the Kaplan-Meier method. Using the Cox appropriate hazard pattern was used to screen the prognostic factors.
Research results
The basic information in the EIPL group and the non-EIPL group had no significant differences. The symptoms of ileus and abdominal abscess appeared more frequently in the non-EIPL group. The multivariate analysis revealed that EIPL, tumor size, vascular invasion, N stage and T stage were independent prognostic factors for the overall survival of patients. The prognosis of the EIPL group was better than the non-EIPL group, and the 3-year survival rate of the EIPL group was higher than the non-EIPL group. For the recurrence-free survival (RFS) of patients, the risk factor included EIPL, N stage, vascular invasion, type of surgery, tumor location, Borrmann classification and tumor size. EIPL and tumor size were independent risk factors. The RFS curve of the EIPL group was better than the non-EIPL group (P = 0.004), and the recurrence rate of the EIPL group was lower than the non-EIPL group. The overall recurrence rate and peritoneum recurrence rate in the EIPL group was lower than the non-EIPL group.
Research conclusions
The overall survival curve and RFS curve were better in the EIPL group. The possibility of perioperative complications, including ileus and abdominal abscess, could be reduced by EIPL.
Research perspectives
EIPL could benefit advanced GC patients because it is inexpensive and easy and would be a promising therapeutic strategy in the future.
