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The benefits of surgery plus extensive intraoperative peritoneal lavage (EIPL) for patients with gastric cancer compared with surgery alone: a systematic review and meta-analysis

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Abstract

This study aims to synthesize the benefits of surgery plus extensive intraoperative peritoneal lavage (EIPL) for patients with gastric cancer compared with surgery alone. We searched Pubmed, Embase, Web of Science, Cochrane library, ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (ICTRP) for randomized controlled trials from 2000 to 2021 according to the inclusion and exclusion criteria. The reference lists of studies meeting the criteria were also screened for additional studies. The quality of these studies was assessed by the Cochrane Collaboration Risk of Bias Tool. An inverse-variance random-effects model of DerSimonian and Laird was used to synthesize the HRs and corresponding 95% CIs of short-term outcomes: hospital mortality and postoperative complications. For long-term outcomes (peritoneal recurrence and 3-year or 5-year overall survival rate), narrative synthesis was used. 4 of 43 studies were included for quantitative analysis. For short-term outcomes, the pooled HRs of hospital mortality and postoperative complications are 0.422 (95%CI: 0.037, 4.790) and 0.774 (95%CI: 0.376, 1.592). For long-term outcomes, despite the inconsistent results, patients receiving EPIL did not have reduced peritoneal recurrence and 3-year or 5-year overall survival rate. Compared with surgery alone, surgery plus EIPL does not have more benefits for patients with gastric cancer.

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References

  1. Kunz PL et al (2012) Long-term survivors of gastric cancer: a California population-based study. J Clin Oncol 30(28):3507–3515

    Article  PubMed  Google Scholar 

  2. Hagiwara A et al (1992) Prophylaxis with carbon-adsorbed mitomycin against peritoneal recurrence of gastric cancer. Lancet 339(8794):629–631

    Article  CAS  PubMed  Google Scholar 

  3. Ferlay J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403

    Article  CAS  PubMed  Google Scholar 

  4. Forman D, Burley VJ (2006) Gastric cancer: global pattern of the disease and an overview of environmental risk factors. Best Pract Res Clin Gastroenterol 20(4):633–649

    Article  CAS  PubMed  Google Scholar 

  5. Cabalag CS et al (2015) A systematic review and meta-analysis of gastric cancer treatment in patients with positive peritoneal cytology. Gastric Cancer 18(1):11–22

    Article  CAS  PubMed  Google Scholar 

  6. Guo J et al (2019) Combined surgery and extensive intraoperative peritoneal lavage vs surgery alone for treatment of locally advanced gastric cancer: the SEIPLUS randomized clinical trial. JAMA Surg 154(7):610–616

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kuramoto M et al (2012) A proposal of a practical and optimal prophylactic strategy for peritoneal recurrence. J Oncol 2012:340380

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sugarbaker PH (1996) Observations concerning cancer spread within the peritoneal cavity and concepts supporting an ordered pathophysiology. Cancer Treat Res 82:79–100

    Article  CAS  PubMed  Google Scholar 

  9. Boku T et al (1990) Prognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer. Br J Surg 77(4):436–439

    Article  CAS  PubMed  Google Scholar 

  10. Kodera Y et al (1999) Peritoneal washing cytology: prognostic value of positive findings in patients with gastric carcinoma undergoing a potentially curative resection. J Surg Oncol 72(2):60–64 (discussion 64-5)

    Article  CAS  PubMed  Google Scholar 

  11. Marutsuka T et al (2003) Mechanisms of peritoneal metastasis after operation for non-serosa-invasive gastric carcinoma: an ultrarapid detection system for intraperitoneal free cancer cells and a prophylactic strategy for peritoneal metastasis. Clin Cancer Res 9(2):678–685

    PubMed  Google Scholar 

  12. Han TS et al (2011) Dissemination of free cancer cells from the gastric lumen and from perigastric lymphovascular pedicles during radical gastric cancer surgery. Ann Surg Oncol 18(10):2818–2825

    Article  PubMed  Google Scholar 

  13. Yu XF et al (2013) D2 lymphadenectomy can disseminate tumor cells into peritoneal cavity in patients with advanced gastric cancer. Neoplasma 60(2):174–181

    Article  CAS  PubMed  Google Scholar 

  14. Yonemura Y et al (2010) Surgical treatment for peritoneal carcinomatosis from gastric cancer. Eur J Surg Oncol 36(12):1131–1138

    Article  CAS  PubMed  Google Scholar 

  15. Leake PA et al (2012) A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer. Gastric Cancer 15(Suppl 1):S27-37

    Article  PubMed  Google Scholar 

  16. Kunisaki C et al (2002) Lack of efficacy of prophylactic continuous hyperthermic peritoneal perfusion on subsequent peritoneal recurrence and survival in patients with advanced gastric cancer. Surgery 131(5):521–528

    Article  PubMed  Google Scholar 

  17. Ishizone S et al (2006) Efficacy of S-1 for patients with peritoneal metastasis of gastric cancer. Chemotherapy 52(6):301–307

    Article  CAS  PubMed  Google Scholar 

  18. Lim S et al (2007) Results following resection for stage IV gastric cancer; are better outcomes observed in selected patient subgroups? J Surg Oncol 95(2):118–122

    Article  PubMed  Google Scholar 

  19. Coccolini F et al (2014) Intraperitoneal chemotherapy in advanced gastric cancer. Meta-analysis of randomized trials. Eur J Surg Oncol 40(1):12–26

    Article  CAS  PubMed  Google Scholar 

  20. Glehen O et al (2004) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 22(16):3284–3292

    Article  CAS  PubMed  Google Scholar 

  21. Glehen O, Mohamed F, Gilly FN (2004) Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol 5(4):219–228

    Article  PubMed  Google Scholar 

  22. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14(2):101–112

  23. Ilhan E et al (2017) The importance of extensive intraoperative peritoneal lavage as a promising method in patients with gastric cancer showing positive peritoneal cytology without overt peritoneal metastasis and other therapeutic approaches. J Invest Surg 30(5):318–324

    Article  PubMed  Google Scholar 

  24. Armijo-Olivo S et al (2012) Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract 18(1):12–18

    Article  PubMed  Google Scholar 

  25. DerSimonian R, Laird N (2015) Meta-analysis in clinical trials revisited. Contemp Clin Trials 45(Pt A):139–145

    Article  PubMed  PubMed Central  Google Scholar 

  26. Higgins JP et al (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  27. Poole C, Greenland S (1999) Random-effects meta-analyses are not always conservative. Am J Epidemiol 150(5):469–475

    Article  CAS  PubMed  Google Scholar 

  28. Kuramoto M et al (2009) Extensive intraoperative peritoneal lavage as a standard prophylactic strategy for peritoneal recurrence in patients with gastric carcinoma. Ann Surg 250(2):242–246

    Article  PubMed  Google Scholar 

  29. Yang HK et al (2021) Extensive peritoneal lavage with saline after curative gastrectomy for gastric cancer (EXPEL): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 6(2):120–127

    Article  PubMed  Google Scholar 

  30. Misawa K et al (2019) Randomized clinical trial of extensive intraoperative peritoneal lavage versus standard treatment for resectable advanced gastric cancer (CCOG 1102 trial). Br J Surg 106(12):1602–1610

    Article  CAS  PubMed  Google Scholar 

  31. Mantovani A et al (2008) Cancer-related inflammation. Nature 454(7203):436–444

    Article  CAS  PubMed  Google Scholar 

  32. Arita T et al (2015) Increase in peritoneal recurrence induced by intraoperative hemorrhage in gastrectomy. Ann Surg Oncol 22(3):758–764

    Article  PubMed  Google Scholar 

  33. Choi AH et al (2020) Peritoneal carcinomatosis in gastric cancer: Are Hispanics at higher risk? J Surg Oncol 122(8):1624–1629

    Article  PubMed  Google Scholar 

  34. Bentrem D et al (2005) The value of peritoneal cytology as a preoperative predictor in patients with gastric carcinoma undergoing a curative resection. Ann Surg Oncol 12(5):347–353

    Article  PubMed  Google Scholar 

  35. Benevolo M et al (1998) Diagnostic and prognostic value of peritoneal immunocytology in gastric cancer. J Clin Oncol 16(10):3406–3411

    Article  CAS  PubMed  Google Scholar 

  36. Tustumi F et al (2016) Detection value of free cancer cells in peritoneal washing in gastric cancer: a systematic review and meta-analysis. Clinics (Sao Paulo) 71(12):733–745

    Article  Google Scholar 

  37. Badgwell B et al (2008) Does neoadjuvant treatment for gastric cancer patients with positive peritoneal cytology at staging laparoscopy improve survival? Ann Surg Oncol 15(10):2684–2691

    Article  PubMed  Google Scholar 

  38. Koganti SB et al (2016) Positive peritoneal lavage cytology—implications for staging and management of gastric cancer. Indian J Surg Oncol 7(4):430–435

    Article  PubMed  PubMed Central  Google Scholar 

  39. Jiang CG et al (2011) Clinicopathological analysis and prognostic significance of peritoneal cytology in Chinese patients with advanced gastric cancer. ANZ J Surg 81(9):608–613

    Article  PubMed  Google Scholar 

  40. Lee SD et al (2012) Prognostic significance of peritoneal washing cytology in patients with gastric cancer. Br J Surg 99(3):397–403

    Article  CAS  PubMed  Google Scholar 

  41. Glehen O et al (2014) GASTRICHIP: D2 resection and hyperthermic intraperitoneal chemotherapy in locally advanced gastric carcinoma: a randomized and multicenter phase III study. BMC Cancer 14:183

    Article  PubMed  PubMed Central  Google Scholar 

  42. Fujita J et al (2012) Survival benefit of bursectomy in patients with resectable gastric cancer: interim analysis results of a randomized controlled trial. Gastric Cancer 15(1):42–48

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Operating Theatre, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050019, China

    Shujun Li & Jiajia Wang

  2. Nursing Department, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050019, China

    Laiyou Li

  3. Department of Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050019, China

    Bibo Tan

  4. School of Nursing, Hebei Medical University, Shijiazhuang, 050019, China

    Shan Xue

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  1. Shujun Li
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  2. Laiyou Li
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  3. Bibo Tan
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  4. Jiajia Wang
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  5. Shan Xue
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Contributions

SL and LL came up with the topic, set the inclusion and exclusion criteria and searched four datasets for relevant literature. BT and JW screened the literature according to the criteria and extracted information that we needed. BT and SX used Stata 14 and Revman Review Manager 5.4.1 to synthesize the outcomes and drew graphs. SL and LL together wrote this paper. All authors read and approved the final manuscript.

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Correspondence to Laiyou Li.

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Li, S., Li, L., Tan, B. et al. The benefits of surgery plus extensive intraoperative peritoneal lavage (EIPL) for patients with gastric cancer compared with surgery alone: a systematic review and meta-analysis. Updates Surg 74, 65–72 (2022). https://doi.org/10.1007/s13304-021-01120-5

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  • DOI: https://doi.org/10.1007/s13304-021-01120-5

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