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Extended intraoperative peritoneal lavage as prophylactic peritoneal recurrence for locally advanced gastric cancer: a prospective randomized trial

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Abstract

Background

To demonstrate whether extensive intraoperative peritoneal lavage (EIPL) could yield better results in overall survival and less recurrence, regardless of peritoneal cytology, compared to standard peritoneal lavage (SPL).

Methods

A prospective randomised multicenter study including 94 patients (47 per arm) to detect a 20% difference in 3-year overall survival in patients with locally advanced tumours without peritoneal carcinomatosis. Three samples of peritoneal fluid were obtained (at the beginning, the end of procedure and after the assigned peritoneal lavage). Clinicopathological and surgical data were analysed by group. Postoperative complications, location of recurrence and surgical approach were evaluated. Overall survival was calculated by the Kaplan–Meier method and the uni/multivariate analysis for prognostic factors was carried out using Cox regression analysis.

Results

A total of 86 patients were analysed (4 excluded per group). No statistical differences were observed in clinicopathological or surgical data between groups, considering both groups well-balanced for analysis. Overall survival at 3 years was 64.3% for SPL vs. 62.3% for EIPL (p 0.421). Only three patients had at least one positive peritoneal cytology (1:2). There were no differences regarding postoperative complications (SPL: 37.2% vs. EIPL: 32.5%, p 0.65) or between location of recurrence and number of recurrences. The number of recurrences did not differ between surgical approaches, but locoregional and peritoneal recurrences were fewer with the laparoscopic approach (p 0.048).

Conclusions

The regular use of extensive peritoneal lavage in patients with locally advanced gastric cancer, regardless of peritoneal cytology, has not been effective as prophylaxis of peritoneal recurrence or better survival.

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Acknowledgements

We wish to express our gratitude to Dr. Salvador Quintana for statistical support and Sylva-Astrik Torossian for her editorial contribution.

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Authors and Affiliations

  1. Department of Surgery, Gastro-Oesophageal Surgery Unit, Hospital Universitari Mútua de Terrassa, University of Barcelona, Plaza Dr. Robert, n. 5, 08221, Terrassa, Barcelona, Spain

    J. Rodríguez-Santiago

  2. Gastro-Oesophageal Surgery Unit, Consorci Sanitari Parc Taulí, Sabadell, Spain

    A. Luna

  3. Gastro-Oesophageal Surgery Unit, Hospital Germans Trias i Pujol, Badalona, Spain

    E. Garsot

  4. Gastro-Oesophageal Surgery Unit, Hospital General de Granollers, Granollers, Spain

    A. Aldeano & A. Rada

  5. Gastro-Oesophageal Surgery Unit, Hospital Sant Pau, Barcelona, Spain

    C. Balagué

Authors
  1. J. Rodríguez-Santiago
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  2. A. Luna
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  3. E. Garsot
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  4. A. Aldeano
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  5. C. Balagué
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  6. A. Rada
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Corresponding author

Correspondence to J. Rodríguez-Santiago.

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None of the authors have any conflict of interest.

Ethical approval

The study was approved by the Clinical Trial Commitee of the the reference hospital (Hospital Universitary Mutua de Terrassa) and the ethics committees of each participating hospital.

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All candidates accepted to participate provided written informed consent.

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Rodríguez-Santiago, J., Luna, A., Garsot, E. et al. Extended intraoperative peritoneal lavage as prophylactic peritoneal recurrence for locally advanced gastric cancer: a prospective randomized trial. Clin Transl Oncol 23, 1857–1865 (2021). https://doi.org/10.1007/s12094-021-02596-8

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  • DOI: https://doi.org/10.1007/s12094-021-02596-8

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