Is dilution the solution in gastric cancer?
Mené dans différents pays d'Asie sur 800 patients atteints d'un cancer gastrique de stade cT3 ou cT4 et devant subir un traitement chirurgical à visée curative (durée médiane de suivi : 2,4 ans), cet essai randomisé multicentrique de phase 3 compare l'intérêt, du point de vue de la survie globale et des effets indésirables, d'ajouter un lavage péritonéal extensif à la chirurgie
In The Lancet Gastroenterology & Hepatology, Han Kwang Yang and colleagues report the outcomes of a randomised phase 3 trial (EXPEL) of the use of extensive intraperitoneal lavage (EIPL) following curative gastrectomy for locally advanced gastric cancer. EIPL, which involves washing the peritoneal cavity with 10 L of normal saline during surgical intervention, is intended to reduce the risk of peritoneal dissemination, a common cause of unsuccessful treatment that is associated with a poor prognosis. Such an intervention could potentially reduce recurrence rates of gastric cancer, which still approach 40% despite advances in multimodal therapy. Peritoneal dissemination might result from cancer cells escaping from the serosal surface, haematogenous-peritoneal transfer, or direct manipulation during surgery.
The Lancet Gastroenterology & Hepatology , commentaire, 2019