Extensive Intraoperative Peritoneal Lavage May Not Improve Gastric Cancer Outcomes

There may not be a significant survival benefit from a surgical procedure for gastric cancer.

Extensive intraoperative peritoneal lavage (EIPL) is typically used to diagnose intra-abdominal bleeding. The results from a 2009 small randomized clinical trial suggest that this surgical procedure may improve survival for patients with gastric cancer due to the removal of intraperitoneal-free cancer cells.

A more recent phase 3 trial, the results of which were presented at the American Society of Clinical Oncology Gastrointestinal Cancers Symposium, suggests that the findings from the 2009 trial may not be accurate.

Included in the new study were 295 patients with histologically confirmed primary gastric adenocarcinoma who were scheduled for total or distal gastrectomy. Patients were randomized to receive EIPL or standard treatment.

Among patients in the EIPL cohort, peritoneal lavage was conducted at least 10 times with 1 liter of saline prior to closing the abdomen, according to the study. In the non-EIPL group, the surgeon conducted lavage with ≤ 3 liters of saline.

The primary endpoint of the trial was disease-fee survival (DFS).

The researchers noted that the median volume of saline in the EIPL group was 10 liters and 3 liters for the non-EIPL group.

The analysis showed that the 3-year DFS was 63.9% among EIPL patients and 59.7% among non-EIPL patients, according to the presentation.

Overall survival was 3 years for patients in the EIPL group and 5 years for those in the non-EIPL group, according to the study.

The investigators conducted a subset analysis and found there were no significant differences in survival among the subgroups.

Although EIPL for patients with gastric cancer was observed to be safe and somewhat effective, the new study results did not meet the primary endpoint of improved disease-free survival, the authors concluded.