Risk Assessment and Preventive Treatment for Peritoneal Recurrence Following Radical Resection for Gastric Cancer.

Lin Xiang,Shuai Jin,Jing Zhang,Peng Zheng,Lei Gao,Yang Yu,Ying Zhang,Ewetse Paul Maswikiti,Hao Chen

doi:10.3389/fonc.2021.778152

Abstract

As the most common recurrence pattern after radical gastric cancer resection, peritoneal recurrence is a major cause of mortality, which affects the prognosis of patients to a very large extent. Peritoneal status and risk of peritoneal recurrence can be evaluated by peritoneal lavage cytology, photodynamic diagnosis, imaging examination, and pathologic analysis. Presently, there is no standard approach for preventing peritoneal recurrence after radical surgery; furthermore, controversies exist regarding the effects of some preventive methods. Among the preventive methods, there are high expectations about the potential of preoperative therapy, surgical skill improvement, hyperthermic intraperitoneal chemotherapy, and postoperative treatment to reduce the incidence of peritoneal recurrence after radical gastrectomy. This study aimed to analyze the results of previous studies on the risk assessment and preventive methods of peritoneal recurrence after radical gastrectomy in recent years. We hope to provide references for better approach to clinical diagnosis and treatment strategies for peritoneal recurrence after radical gastrectomy.

Highlights

As a common malignant tumor of the digestive system, gastric cancer (GC) has the fifth highest incidence among malignant tumors worldwide and the third highest fatality rate, and there has been a significant increase in its incidence in East Asia [1]
The time to peritoneal relapse in patients with macroscopic serosal lesions was considerably shorter than that in patients without serosal lesions (P < 0.001), and the 5-year peritoneal recurrence rates were 32.8 and 8.7%, respectively. These results suggest that the macroscopic assessment of serosal lesions may be a useful index to predict the risk of peritoneal recurrence after radical resection [75]
The occurrence of peritoneal metastasis after radical gastrectomy seriously affects the prognosis of patients to a great extent, and how to identify patients at a high risk of peritoneal recurrence and develop preventive treatment approaches quickly is vital for the reduction of postoperative peritoneal metastasis

Summary

INTRODUCTION

As a common malignant tumor of the digestive system, gastric cancer (GC) has the fifth highest incidence among malignant tumors worldwide and the third highest fatality rate, and there has been a significant increase in its incidence in East Asia [1]. The CCOG1102 trial showed the opposite results of no significant difference in peritoneal relapse-free survival rate (P = 0.676) and DFS and OS between the EIPL and non-EIPL groups after radical gastrectomy In this trial, EIPL could neither reduce postoperative peritoneal dissemination nor improve the prognosis of patients, but it seemed to ameliorate DFS for patients with higher intraoperative blood loss or postoperative abdominal infection [68]. The hematogenous site and node recurrence rates in the combination group are significantly lower than that in the S-1-alone group, there was no statistically significant difference between these two groups in peritoneal relapse (9.3 vs 12.9%, P = 0.092) This suggests that S1, combined with docetaxel adjuvant chemotherapy regimen, does not improve peritoneal metastasis after radical resection of GC compared with S-1 monotherapy [88]. Drug selection and therapeutic regimen are crucial for the appropriate method, and this still needs to be supported with a large number of clinical studies

CONCLUSIONS

Findings

Method