Extensive peritoneal lavage cuts complications from gastric-cancer surgery

Last Updated: 2019-04-09

By David Douglas

NEW YORK (Reuters Health) - Extensive intraoperative peritoneal lavage (EIPL) during resection of peritoneal metastasis from gastric cancer increases safety and reduces short-term complications, according to Chinese researchers.

EIPL has been shown to reduce the number of intraperitoneal free cancer cells, potentially reducing peritoneal metastasis, note Dr. Dazhi Xu of Sun Yat-sen University Cancer Center, in Guangzhou, and colleagues in JAMA Surgery, online March 27.

However, the safety and efficacy of the approach has not been defined, they add. To help do so, the researchers randomly assigned 662 patients with advanced gastric cancer to D2 gastrectomy with or without EIPL; in the end, 550 were operated on at 11 centers between 2016 and 2017.

EIPL was performed ten times using one liter of physiological saline each time. The surgery-alone group underwent no more than two lavage sessions involving less than three liters of saline in total.

There were no deaths among the 279 patients assigned to the EIPL group, while five of the 271 who received surgery alone died (1.9%, P=0.02).

There were also significant differences in overall postoperative complications (11.1% vs. 17.0%) and postoperative pain (10.8% vs. 17.7%) in favor of the EIPL group. And there were fewer cases of intra-abdominal bleeding in the EIPL group (1.08% vs. 2.58%).

It was recommended that all patients receive postoperative systemic chemotherapy. Overall survival is still being assessed over three years of follow-up, but given the significantly reduced short-term postoperative complications, wound pain, and mortality, the researchers conclude that "EIPL is a promising and exciting therapeutic strategy for patients with advanced gastric cancer."

In an accompanying editorial, Dr. Edward A. Levine of Wake Forest University, in Winston-Salem, North Carolina, notes, "Gastric cancer is the second leading cause of death from cancer worldwide. Consequently, prevention of peritoneal metastases after resection remains a substantial clinical need."

However, he adds, "we must wait at least until 2020 for survival outcomes."

Dr. Levine told Reuters Health by email that the authors should be congratulated for their ambitious study and that the decrease in pain achieved is impressive. Overall, he concluded, "in the short term, the approach is elegant in its simplicity, safety, and low cost, as well as having the potential to decrease the incidence of dreaded peritoneal metastases in the long-term."

Dr. Xu did not respond to requests for comments.

SOURCE: https://bit.ly/2OZS0OG and https://bit.ly/2GbxEPu

JAMA Surgery 2019.