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10 april 2019: Lees ook dit artikel:
https://kanker-actueel.nl/robot-operatietechniek-bij-beginnende-maagkanker-lijkt-beter-en-veiliger-dan-kijkoperatie-laparoscopisch-blijkt-uit-grote-vergelijkende-langjarige-studie.html
10 april 2019: Bron: JAMA Surg. Published online March 27, 2019
Het spoelen van de buikholte / buikvlies (EIPL = extensive intraoperative peritoneal lavage ) met zout water of verwarmde chemo tijdens een operatie van gevorderde maagkanker is al jaren een veel gebruikte methode in de meeste ziekenhuizen. Omdat daarmee als eerste nog niet aantoonbare kankercellen zouden kunnen worden gedood (chemospoelingen) maar vooral om ernstige complicaties tot aan overlijden aan toe te voorkomen door aanwezige bacterien enz.. Nu heeft een grote gerandomiseerde studie bij totaal 550 volwassenen met maagkanker aangetoond dat dit ook echt zo is.
- De algehele postoperatieve complicaties die zich voordeden na alleen chirurgie (17%) was significant hoger dan na gecombineerde chirurgie en spoelingen (11,1%).
- Patiënten die chirurgie en spoelingen ondergingen, hadden ook een lager risico op overlijden. In de groep die naast de operatie een spoeling kregen overleed niemand gerelateerd aan de operatie. Tegenover 5 patienten die overleden gerelateerd aan de operatie in de groep die alleen een operatie hadden gehad.
- Ook postoperatieve pijn was in vergelijking met patiënten die alleen een operatie ondergingen in de combinatiegroep minder.
Het studierapport: Combined Surgery and Extensive Intraoperative Peritoneal Lavage vs Surgery Alone for Treatment of Locally Advanced Gastric Cancer The SEIPLUS Randomized Clinical Trial is gepubliceerd in JAMA Surgery en is tegen betaling in te zien.
Hier het abstract van de studie:
March 27, 2019
Combined Surgery and Extensive Intraoperative Peritoneal Lavage vs Surgery Alone for Treatment of Locally Advanced Gastric CancerThe SEIPLUS Randomized Clinical Trial
JAMA Surg. Published online March 27, 2019. doi:10.1001/jamasurg.2019.0153
Key Points
Question How do the short-term outcomes following combined surgery and extensive intraoperative peritoneal lavage compare with those of open surgery alone for treatment of locally advanced gastric cancer?
Findings In this multicenter randomized clinical trial that included 550 adults, the overall postoperative complication rate following surgery alone (17%) was significantly higher than that following combined surgery and lavage (11.1%). Patients receiving surgery plus lavage also exhibited reduced mortality and postoperative pain compared with those receiving surgery alone.
Meaning Patients may benefit from the addition of extensive intraoperative peritoneal lavage with surgery for treatment of locally advanced gastric cancer.
Importance Peritoneal metastasis is the most frequent pattern of postoperative recurrence in patients with gastric cancer. Extensive intraoperative peritoneal lavage (EIPL) is a new prophylactic strategy for treatment of peritoneal metastasis of locally advanced gastric cancer; however, the safety and efficacy of EIPL is currently unknown.
Objective To evaluate short-term outcomes of patients with advanced gastric cancer who received combined surgery and EIPL or surgery alone.
Design, Setting, and Participants From March 2016 to November 2017, 662 patients with advanced gastric cancer receiving D2 gastrectomy were enrolled in a large, multicenter, randomized clinical trial from 11 centers across China. In total, 329 patients were randomly assigned to receive surgery alone, and 333 patients were randomly assigned to receive surgery plus EIPL. Clinical characteristics, operative findings, and postoperative short-term outcomes were compared between the 2 groups in the intent-to-treat population.
Main Outcomes and Measures Short-term postoperative complications and mortality.
Results The present analysis included data from 550 patients, 390 men and 160 women, with a mean (SD) age of 60.8 (10.7) years in the surgery alone group and 60.6 (10.8) in the surgery plus EIPL group. Patients assigned to the surgery plus EIPL group exhibited reduced mortality (0 of 279 patients) compared with those assigned to surgery alone (5 of 271 patients [1.9%]) (difference, 1.9%; 95% CI, 0.3%-3.4%; P = .02). A significant difference in the overall postoperative complication rate was observed between patients receiving surgery alone (46 patients [17.0%]) and those receiving surgery plus EIPL (31 patients [11.1%]) (difference, 5.9%; 95% CI, 0.1%-11.6%; P = .04). Postoperative pain occurred more often following surgery alone (48 patients [17.7%]) than following surgery plus EIPL (30 patients [10.8%]) (difference, 7.0%; 95% CI, 0.8%-13.1%; P = .02).
Conclusions and Relevance Inclusion of EIPL can increase the safety of D2 gastrectomy and decrease postoperative short-term complications and wound pain. As a new, safe, and simple procedure, EIPL therapy is easily performed anywhere and does not require any special devices or techniques. Our study suggests that patients with advanced gastric cancer appear to be candidates for the EIPL approach.
Trial Registration ClinicalTrials.gov identifier: NCT02745509
extensive intraoperative peritoneal lavage, EIPL, maagkanker, ernstige complicaties, risico op overlijden
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