Effect of intraperitoneal chemotherapy and peritoneal lavage in positive peritoneal cytology in gastric cancer. Systematic review and meta-analysis

Abstract Introduction The most common cause of tumor 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...

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Bibliographic Details
Published in:European journal of surgical oncology 2016-09, Vol.42 (9), p.1261-1267
Main Authors: Coccolini, Federico, MD, Catena, Fausto, Glehen, Olivier, Yonemura, Yutaka, Sugarbaker, Paul H, Piso, Pompiliu, Ceresoli, Marco, Montori, Giulia, Ansaloni, Luca
Format: Article
Language:English
Subjects:
Antineoplastic Agents - therapeutic use
Carcinoma - secondary
Carcinoma - therapy
Cytoreduction
Gastric cancer
Hematology, Oncology and Palliative Medicine
Humans
Infusions, Parenteral
Intraperitoneal chemotherapy
Meta-analysis
Mortality
Peritoneal Cavity
Peritoneal Lavage - methods
Peritoneal Neoplasms - secondary
Peritoneal Neoplasms - therapy
Positive cytology
Prognosis
Stomach Neoplasms - pathology
Stomach Neoplasms - therapy
Surgery
Survival
Survival Rate
Therapeutic Irrigation - methods
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Summary:Abstract Introduction The most common cause of tumor 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 tumor 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-. Material and 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). 2 and 5 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 intra-peritoneal chemotherapy. Peritoneal lavage further increases these survival rates and also it further decreases the peritoneal recurrence rate.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2016.03.035