Abstract
Peritoneal carcinomatosis is the most frequent pattern of metastasis and recurrence in patients with gastric cancer, and the prognosis of those patients with peritoneal metastasis is extremely poor. Once peritoneal metastasis is formed, it is extremely difficult to overcome. EIPL (extensive intraoperative peritoneal lavage) is a quite useful and practical adjuvant surgical technique for the gastric cancer patients who are likely to suffer from peritoneal recurrence. EIPL includes 10 times of an extensive shake and wash of abdominal cavity with saline followed by the complete aspiration of the fluid after potentially curative operation, which is supposed to have an amazing cyto-reduction power. The purpose of this article is to review the effect of EIPL on prevention of peritoneal recurrence in the patients with peritoneal free cancer cells and to evaluate its validity as a standard prophylactic strategy against peritoneal recurrence in gastric cancer.
Highlights
Recent advances in diagnostic and surgical techniques have improved the prognosis of early gastric cancer, whereas advanced gastric cancer still remains a lifethreatening disease
It is already generally accepted that peritoneal metastasis is completed by implantation of peritoneal free cancer cells exfoliated from serosa-invasive tumors through the process of fixation and progression of cancer cells on the peritoneum
As there should be a low risk of the completion of peritoneal metastasis in such cases with non-serosal-involved gastric cancer, extensive intraoperative peritoneal lavage” (EIPL) therapy will demonstrate its effectiveness to the maximum on the prevention of peritoneal recurrences after curative operations
Summary
Recent advances in diagnostic and surgical techniques have improved the prognosis of early gastric cancer, whereas advanced gastric cancer still remains a lifethreatening disease. Stage IV gastric cancer, including peritoneal metastasis, is considered incurable and this population is usually ineligible for radical operation. There would still remain something that we can do If this supposition is true, the number of free cancer cells could be reduced to potentially zero by just like the so-called “limiting dilution method”. The peritoneal cavity is extensively stirred and washed after the potentially curative operation, which is followed by the complete aspiration of the fluid. This procedure is done 10 times using 1L of physiological saline. Our preliminary subset analysis based on 22 consecutive patients with CY+/P− who underwent curative surgical treatment for advanced gastric cancer, and who were followed up for 2 years or until death, has shown a statistically significant improvement of a 2-year survival rate when treated with EIPL as compared with when not treated with EIPL [15]
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