title: Effect of intraperitoneal chemotherapy and peritoneal lavage in positive peritoneal cytology in gastric cancer. Systematic review and meta-analysis.
abstract: BACKGROUND
  The most common cause of tumour progression in advanced gastric cancer is peritoneal carcinosis (PC). The necessity to increase the survival in advanced diseases suggested to deliver the chemotherapy directly in the peritoneal cavity also in Cy+/PC- and to experiment the effect of massive peritoneal lavage to wash out the tumour cells. The aim of this study is to investigate the gain in term of survival and peritoneal recurrence rate of the intraperitoneal chemotherapy and/or peritoneal lavage in patients with Cy+/PC-.
  
  
  METHODS
  A systematic review with meta-analysis of trials about the effect of intraperitoneal chemotherapy (IPC) and/or peritoneal lavage (PL) on positive cytology in gastric cancer without carcinosis.
  
  
  RESULTS
  Three trials have been included (164 patients: 76 received surgery alone, 51 surgery + IPC and 37 surgery + IPC + PL). Two- and five-years survival is increased by IPC (RR = 1.62, RR = 3.10). 2 and 5 years survival is further increased by IPC + PL (RR = 2.33, RR = 6.19). Peritoneal recurrence is reduced by IPC (OR = 0.45) and by IPC + PL (OR = 0.13).
  
  
  CONCLUSIONS
  Two- and five-years overall survival in patients with free cancer cells without carcinosis is incremented by intraperitoneal chemotherapy. Peritoneal lavage further increases these survival rates and also it further decreases the peritoneal recurrence rate.
authors.affiliation: General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy. Electronic address: federico.coccolini@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Coccolini
authors.affiliation: General Surgery Department, Ospedale Maggiore, Parma, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Catena
authors.affiliation: General Surgery Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon and EMR 3738, Université Lyon 1, France.
authors.forename: O
authors.initials: O
authors.lastname: Glehen
authors.affiliation: General Surgery Department, Kusatsu General Hospital, Yabase 1660, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yonemura
authors.affiliation: Washington Cancer Institute, Washington, DC, USA.
authors.forename: P H
authors.initials: PH
authors.lastname: Sugarbaker
authors.affiliation: Surgery Department, University of Regensburg, Regensburg D-93053, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Piso
authors.affiliation: General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ceresoli
authors.affiliation: General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Montori
authors.affiliation: General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Ansaloni
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002277:Carcinoma / Q000556:secondary / Q000628:therapy*; D006801:Humans; D007263:Infusions, Parenteral; D010529:Peritoneal Cavity; D010533:Peritoneal Lavage / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D007507:Therapeutic Irrigation / Q000379:methods
chemical_list: D000970:Antineoplastic Agents
keywords: Cytoreduction; Gastric cancer; Intraperitoneal chemotherapy; Meta-analysis; Mortality; Positive cytology; Surgery; Survival