Extensive Intraoperative Peritoneal Lavage to Prevent Metastases From Gastric Cancer: The Elegance of Simplicity

Mené en Chine sur 550 patients atteints d'un cancer de l'estomac de stade localement avancé (âge moyen : environ 61 ans ; 390 hommes), cet essai multicentrique évalue, du point de vue des complications post-opératoires et de la mortalité, l'intérêt d'ajouter un lavage péritonéal extensif intra-opératoire à une gastrectomie D2

Résumé en anglais

Gastric cancer is the second leading cause of death from cancer worldwide. Consequently, prevention of peritoneal metastases after resection remains a substantial clinical need. Gastric cancer is more likely than other gastrointestinal malignant neoplasms to metastasize to peritoneal sites, and survival with peritoneal metastases is less than a year. Although systemic therapy for gastric cancer has improved, it has not prevented peritoneal dissemination. There has been interest in intraperitoneal approaches to preventing peritoneal dissemination since the 1980s. Hyperthermic intraperitoneal chemotherapy following radical gastrectomy initially found promising results in randomized trials. However, methodologic flaws and long-term follow-up did not bring this into common practice. An elegantly simple approach of extensive intraoperative peritoneal lavage (EIPL) was suggested to decrease gastric cancer cells shed into the operative field. That study found substantially improved outcomes with EIPL and intraperitoneal cisplatin vs intraperitoneal therapy and surgery alone.