Gastric cancer is typically treated with surgical resection followed by chemotherapy. Peritoneal metastasis, caused by direct cancer cell dissemination, is the most common pattern of postoperative recurrence; the prognosis of patients with peritoneal metastasis is very poor. Extensive intraoperative peritoneal lavage (EIPL) is one strategy that has been developed to prevent peritoneal dissemination. Currently, three studies are ongoing to assess the efficacy and safety of prophylactic EIPL for peritoneal recurrence of locally advanced gastric cancer. In this ongoing randomized controlled trial, 662 patients with locally advanced gastric cancer receiving open D2 gastrectomy were assigned to receive surgery alone or surgery plus EIPL to study short-term postoperative complications and mortality. Researchers found that there were significantly more deaths in the surgery alone group than in the surgery plus EIPL group (difference 1.9%, 95% CI 0.3% to 3.4%, p=0.02). Postoperative complications were more frequent in the surgery alone group than in the surgery plus EIPL group (17.0% vs. 11.1%, difference 5.9%, 95% CI 0.1% to 11.6%, p=0.04). Additionally, postoperative pain was more common in the surgery alone group than in the surgery plus EIPL group (17.7% vs. 10.8%, respectively, difference 7.0%, 95% CI 0.8% to 13.1%, p=0.02). Notably, 112 patients (16.9%) were excluded after randomization due to the finding of T1, T2, or M1 disease on histopathology, which may reduce the quality of the study. Overall, this trial supports the use of EIPL as a therapeutic strategy for patients with advanced gastric cancer. Future analysis will study the primary endpoint of 3-year overall survival.
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