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Combined Surgery and Extensive Intraoperative Peritoneal Lavage vs Surgery Alone for Treatment of Locally Advanced
Jing Guo1, Aman Xu2, Xiaowei Sun1
1State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
JAMA Surgery
|March 28, 2019
Summary
Extensive intraoperative peritoneal lavage (EIPL) is a safe and effective method to reduce postoperative complications and pain in advanced gastric cancer patients undergoing D2 gastrectomy. This new approach enhances surgical safety and patient recovery.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Peritoneal metastasis is a common cause of recurrence in gastric cancer patients post-surgery.
- Extensive intraoperative peritoneal lavage (EIPL) is a novel prophylactic strategy for peritoneal metastasis in advanced gastric cancer.
- The safety and efficacy of EIPL remain largely unknown.
Purpose of the Study:
- To evaluate the short-term outcomes of advanced gastric cancer patients who underwent D2 gastrectomy.
- To compare outcomes between patients receiving surgery alone versus surgery plus EIPL.
Main Methods:
- A large, multicenter, randomized clinical trial involving 662 patients with advanced gastric cancer across 11 centers in China.
- Patients were assigned to either surgery alone (329 patients) or surgery plus EIPL (333 patients).
- Short-term postoperative complications and mortality were the primary outcome measures.
Main Results:
- The surgery plus EIPL group showed significantly reduced mortality (0% vs. 1.9%, P=.02).
- Overall postoperative complication rates were lower in the EIPL group (11.1% vs. 17.0%, P=.04).
- Postoperative pain was also less frequent in the EIPL group (10.8% vs. 17.7%, P=.02).
Conclusions:
- Extensive intraoperative peritoneal lavage (EIPL) improves the safety of D2 gastrectomy.
- EIPL significantly decreases postoperative complications and pain in advanced gastric cancer patients.
- EIPL is a simple, safe, and easily applicable procedure suitable for patients with advanced gastric cancer.
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