title: Extensive intraoperative peritoneal lavage as a standard prophylactic strategy for peritoneal recurrence in patients with gastric carcinoma.
abstract: OBJECTIVE
  This prospective randomized multicenter study aims to evaluate the efficacy of extensive intraoperative peritoneal lavage followed by intraperitoneal chemotherapy (EIPL-IPC) on the overall 5-year survival of advanced gastric cancer patients with intraperitoneal free cancer cells without overt peritoneal metastasis (CY+/P-). The study also aims to determine the merit and reliability of EIPL-IPC therapy as a prophylactic strategy for peritoneal metastasis.
  
  
  BACKGROUND
  Although the prognosis of advanced gastric cancer patients with CY+/P- is extremely poor, a suitable standard regimen for treating such patients has not yet been established.
  
  
  METHODS
  A total of 88 patients with CY+/P- from 1522 patients with advanced gastric cancer at multicenters were enrolled in this study and were randomly allocated to 3 groups: surgery alone group, surgery plus intraperitoneal chemotherapy (IPC) group, and surgery plus EIPL and IPC (EIPL-IPC) group. Prognostic significance of EIPL-IPC therapy was evaluated by Kaplan-Meier curves, and its value as an independent prognostic factor was assessed by univariate and multivariate analyses.
  
  
  RESULTS
  The overall 5-year survival rate of the patients with EIPL-IPC was 43.8%, and this data were significantly better than that of the IPC group (4.6%, P < 0.0001) and the surgery alone group (0%, P < 0.0001). Among various recurrent patterns, the EIPL-IPC group had a significantly lower incidence of peritoneal recurrence than both of the other groups (P < 0.0001). Univariate and multivariate analyses revealed that EIPL was the most significant impact factor.
  
  
  CONCLUSIONS
  The present study clearly revealed that EIPL-IPC therapy significantly improved the 5-year survival span of advanced gastric cancer patients with CY+/P-. Thus, EIPL-IPC therapy is strongly recommended as a standard prophylactic strategy for peritoneal dissemination.
authors.affiliation: Department of Surgery, Yatsushiro Social Insurance General Hospital, Kumamoto, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kuramoto
authors.forename: Shinya
authors.initials: S
authors.lastname: Shimada
authors.forename: Satosi
authors.initials: S
authors.lastname: Ikeshima
authors.forename: Akinobu
authors.initials: A
authors.lastname: Matsuo
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yagi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsuda
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yonemura
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002277:Carcinoma / Q000401:mortality / Q000517:prevention & control* / Q000556:secondary*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010533:Peritoneal Lavage; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000517:prevention & control* / Q000556:secondary*; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents