A comparative study of the therapeutic efficacy of intraoperative single lavage chemotherapy versus combined postoperative intraperitoneal hyperthermic chemotherapy with lobaplatin in patients with t4 gastric cancer

ZHANG Jing; SHAO Xinxin; HU Haitao; TIAN Yantao; ZHONG Yuxin

doi:10.3969/j.issn.1674-4136.2024.02.011

Abstract：Objective This study aimed to assess the effectiveness and safety of intraoperative intraperitoneal chemotherapy combined with postoperative intraperitoneal hyperthermic perfusion chemotherapy using lobaplatin in the treatment of T4 stage gastric cancer following radical surgery.Methods A retrospective analysis was conducted on clinical data of 72 T4 stage gastric cancer patients who underwent gastrectomy with intraoperative intraperitoneal chemotherapy from September 2018 to September 2020 at the Cancer Hospital of the Chinese Academy of Medical Sciences and Huanxing Cancer Hospital.Patients were divided into two groups based on whether postoperative hyperthermic chemotherapy was performed.The study group included 36 cases with intraoperative intraperitoneal chemotherapy combined with postoperative intraperitoneal hyperthermic chemotherapy with lobaplatin,and the control group comprised 36 cases with intraoperative intraperitoneal lobaplatin chemotherapy alone.Baseline data and perioperative information,including conversion rate of laparotomy,operation time,intraoperative blood loss,hospital stay,30-day postoperative mortality,time to passage of flatus,time to resume oral intake,postoperative complication rate,changes of hematological indexes and peritoneal recurrence,were compared between the two groups.Survival analysis was conducted to compare total survival rates and disease-free survival rates.Results There was no significant difference in the incidence of postoperative complications between the two groups(P＞0.05).Both groups showed mild thrombocytopenia and leukopenia(χ2=0.167,P=0.683),abnormal renal function(χ2 =0,P=1),and abnormal liver function(χ2=0.278,P=0.599),but the difference was not statistically significant.The average follow-up time was 35.1 months.In comparison,postoperative intraperitoneal lobaplatin lavage demonstrated a statistically significant difference in peritoneal recurrence compared to combined postoperative intraperitoneal hyperthermic lobaplatin chemotherapy(χ2= 3.611,P= 0.046).The 3-year overall survival rate(P= 0.764)and 3-year disease-free survival rate(P= 0.911)were not significantly different in both groups.Conclusions Postoperative single intraperitoneal chemotherapy and combined postoperative intraperitoneal hyperthermic chemotherapy with lobaplatin are safe and feasible in T4 gastric cancer patients.Postoperative intraperitoneal hyperthermic chemotherapy with lobaplatin can reduce the risk of peritoneal metastasis.