Preventing prolonged post-operative ileus in gastric cancer patients undergoing gastrectomy and intra-peritoneal chemotherapy.
OBJECTIVE
To assess the efficacy of metoclopramide (Met) for prevention of prolonged post-operative ileus in advanced gastric cancer patients undergoing D2 gastrectomy and intra-peritoneal chemotherapy (IPC).


METHODS
Thirty-two advanced gastric cancer patients undergoing D2 gastrectomy and IPC were allocated to two groups. Sixteen patients received Met immediately after operation (group A), and 16 did not (group B). Another 16 patients who underwent D2 gastrectomy without IPC were enrolled as the control group (group C). All patients had received epidural pain control. The primary endpoints were time to first post-operative flatus and time until oral feeding with a soft diet without discomfort. Secondary endpoints were early complications during hospitalization.


RESULTS
Gender, the type of resection, operating time, blood loss, tumor status and amount of narcotics were comparable in the three groups. However, the group C patients were older than those in groups A and B (67.5+/-17.7 vs 56.8+/-13.2, 57.5+/-11.7 years, P = 0.048). First bowel flatus occurred after 4.35+/-0.93 d in group A, 4.94+/-1.37 d in group B, and 4.71+/-1.22 d in group C (P>0.05). Oral feeding of a soft diet was tolerated 7.21+/-1.92 d after operation in group A, 10.15+/-2.17 d in group B, and 7.53+/-1.35 d in group C (groups A and C vs group B, P<0.05). There was no significant difference in respect to the first flatus among the three groups. However, the time of tolerating oral intake with soft food in groups A and C patients was significantly shorter than that in group B patients. Levels of C-reactive protein (CRP) were significantly lower in group C and there was a more prominent and prolonged response in CRP level in patients undergoing IPC. The incidence of post-operative complications was similar in the three groups except for prolonged post-operative ileus. There was no increased risk of anastomotic leakage in patients receiving Met.


CONCLUSIONS
The results suggest that a combination of intravenous Met and epidural pain control may be required to achieve a considerable decrease in time to resumption of oral soft diet in advanced gastric cancer patients who underwent gastrectomy and IPC. Furthermore, the administration of Met did not increase anastomotic leakage. Met has a role in the prevention of prolonged post-operative ileus.
Chan
De-Chuan
DC
Division of General Surgery, National Defense Medical Center, National Defense University, Taipei 114, Taiwan, China. chrischan1168@yahoo.com.tw
Liu
Yao-Chi
YC
Chen
Cheng-Jueng
CJ
Yu
Jyh-Cherng
JC
Chu
Heng-Cheng
HC
Chen
Fa-Chang
FC
Chen
Teng-Wei
TW
Hsieh
Huan-Fa
HF
Chang
Tzu-Ming
TM
Shen
Kuo-Liang
KL
D000328:Adult; D000368:Aged; D018492:Dopamine Antagonists / Q000627:therapeutic use*; D004573:Electrolytes / Q000097:blood; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D045823:Ileus / Q000517:prevention & control*; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D008875:Middle Aged; D010149:Postoperative Pain; D011183:Postoperative Complications / Q000517:prevention & control*; D013274:Stomach Neoplasms / Q000601:surgery*
D018492:Dopamine Antagonists; D004573:Electrolytes; D008787:Metoclopramide