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.
Peritoneal invasion is more common and has a worse prognosis in gastric cancer than most of other intestinal cancers. Advanced gastric cancers have a poor course in terms of the development of peritoneal carcinomatosis and prognosis, even if the curative resection has been performed. Patients usually die within the first 2 years of the postoperative period mainly due to peritoneal metastasis. It is, therefore, essential to eradicate intraperitoneal free cancer cells to prevent peritoneal recurrences. A standard therapy has not been developed yet for patients with gastric cancer with a positive peritoneal cytology or a gross peritoneal metastasis. Curative resection following neoadjuvant chemotherapy, postoperative oral S-1 chemotherapy, intraoperative intraperitoneal chemotherapy (IPC), and extensive intraoperative peritoneal lavage (EIPL)-IPC are recommended as therapeutic approaches. Although there is a limited number of studies on EIPL, which is a promising and exciting method in this patient population, unexpected results of survival have been demonstrated. We consider that the results of ongoing and further studies would lead to an extensive use of EIPL, which is a simple and easy method which can be applied anywhere and anytime, in patients with advanced gastic cancer and/or peritoneal cytology positive but peritoneal metastasis negative (CY+/P0) gastric cancer.
a Izmir Bozyaka Training and Research Hospital, The Division of General Surgery-A , Karabaglar , 35170 Turkey.
Enver
E
Ilhan
b Okmeydani Training and Research Hospital, The Division of General Surgery , Okmeydani , 34384 Turkey.
Ali
A
Alemdar
a Izmir Bozyaka Training and Research Hospital, The Division of General Surgery-A , Karabaglar , 35170 Turkey.
Orhan
O
Ureyen
a Izmir Bozyaka Training and Research Hospital, The Division of General Surgery-A , Karabaglar , 35170 Turkey.
Koray
K
Bas
D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D004338:Drug Combinations; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods; D007430:Intraoperative Care; D020360:Neoadjuvant Therapy; D010094:Oxonic Acid / Q000627:therapeutic use; D010533:Peritoneal Lavage; D010534:Peritoneal Neoplasms / Q000517:prevention & control*; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000601:surgery*; D005641:Tegafur / Q000627:therapeutic use
D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid
extensive intraoperative peritoneal lavage; gastric cancer; intraperitoneal chemotherapy; neoadjuvant chemotherapy; peritoneal cytology; survival