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Efficacy and Safety of Extensive Intraperitoneal Lavage for Patients with Gastric Cancer — A Systematic Review and Meta-analysis

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Abstract

Purpose

Extensive  intraperitoneal lavage (EIPL) is a novel therapeutic intervention that aims to limit the chance of peritoneal metastasis during gastrectomy. Clinical trials on using EIPL after gastrectomy show controversial results. We aimed to summarize the evidence of efficacy and safety for using EIPL after gastrectomy to limit the possibility of peritoneal metastasis and improve survival.

Methods

A literature search on PubMed, Scopus, Embase, and Web of Sciences was conducted till June 2023 to identify eligible RCTs that assess the efficacy and safety of EIPL after gastrectomy. The hazard ratio with 95% CI was used to determine the survival probability, the risk ratio with 95% CI was used to assess the surgical outcomes, and ROB-2 and GRADE guidelines were used to assess the risk of bias and the certainty of evidence respectively.

Results

Six eligible studies with a total of 1993 patients were included in the meta-analysis. Regarding survival benefits, the survival of the EIPL group did not differ significantly from the non-EIPL group, and the pooled HR of overall survival was 0.86 (95% CI 0.58–1.26) P = 0.44, the disease-free survival was 0.81 (0.58–1.13) P = 0.21, and peritoneal recurrence-free survival was 0.97 (0.79–1.2) P = 0.25. There is no significant association between EIPL and short-term postoperative outcomes. The use of EIPL does not appear to affect postoperative mortality, infection, anastomotic leakage, bleeding, ileus, or hospital stay.

Conclusion

Our study yielded insufficient evidence about the survival benefits and surgical outcomes of EIPL in patients with gastric cancer after gastrectomy. Therefore, it is not recommended for treating gastric cancer patients.

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Data Availability

The data used in this manuscript are available by contacting the corresponding author upon reasonable request.

Abbreviations

EIPL:

Extensive intraperitoneal lavage

CY+/P-:

Positive peritoneal cytology without macroscopic metastasis

OS:

Overall survival

DFS:

Disease-free survival

PFS:

Peritoneal recurrence-free survival

POM:

Postoperative mortality

POB:

Postoperative bleeding

POIL:

Postoperative ileus

HS:

Hospital stay

IPC:

Intraperitoneal chemotherapy

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Authors and Affiliations

  1. Faculty of Medicine, Elmergib University, Al-Khums, Libya

    Qasi Najah

  2. Medical Research Group of Libya, Negida Academy, Arlington, MA, USA

    Qasi Najah & Ayah Alsubayhay

  3. Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA

    Amro Mamdouh Abdelrehim, Mohamed Elmallahy & Yasmeen Jamal Alabdallat

  4. Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt

    Amro Mamdouh Abdelrehim

  5. Faculty of Medicine, Tanta University, Tanta, Egypt

    Mohamed Elmallahy

  6. Faculty of Medicine, University of Benghazi, Benghazi, Libya

    Ayah Alsubayhay

  7. Faculty of Medicine, Hashemite University, 13133, Zarqa, Jordan

    Yasmeen Jamal Alabdallat

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  1. Qasi Najah
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Contributions

Qasi Najah: study design and conceptualization, data analysis, and writing the first draft. Amro Mamdouh Abdelrehim: data collection, material preparation, and revising the manuscript. Mohamed Elmallahy: data collection, material preparation, and revising the manuscript. Ayah Alsubayhay: data collection, material preparation, and revising the manuscript. Yasmeen Jamal Alabdallat: data visualization, revising the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Qasi Najah.

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This study did not involve human participants or animals.

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Najah, Q., Abdelrehim, A.M., Elmallahy, M. et al. Efficacy and Safety of Extensive Intraperitoneal Lavage for Patients with Gastric Cancer — A Systematic Review and Meta-analysis. J Gastrointest Canc 55, 96–104 (2024). https://doi.org/10.1007/s12029-023-00971-y

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