Objective To evaluate the curative effectiveness and safety of prophylactic chemohyperthermic peritoneal perfusion (CHPP) during the radical surgery of advancing gastric cancer.
Methods We searched MEDLINE (1980 to December 2002), EMBASE (1989 to December 2002), BIOSIS Previews (1980 to December 2002), Cochrane Controlled Trials Register (Issue 4, 2003) and CBMdisc (1981 to December 2002). Randomized or quasi-randomized controlled trials comparing curative gastrectomy (CG) plus CHPP with CG for advancing gastric cancer were collected. The methodological quality of included studies was assessed, and a meta-analysis was performed by RevMan 4.2 software.
Results Seven RCTs involving 744 patients met the selection criteria, all trials were of lower methodological quality. ① Meta-analysis results showed that no significant difference was found comparing CG plus CDDP (cisplatin) with CG for peritoneal recurrence after operation (The pooled OR 0.69，95%CI 0.43 to 1.12). Compared with CG alone, CG plus CDDP plus MMC significantly reduced peritoneal recurrence after operation during ≥5 years follow up (OR 0.05, 95% CI 0.01 to 0.37), but this effect was not seen during lt; 5 years follow up (OR 0.35，95%CI 0.06 to 2.10). ② CG plus CDDP significantly reduced mortality after operation during ＜5 and ≥5 years follow up, compared with CG alone (OR 0.25, 95%CI 0.08 to 0.75; the pooled OR 0.62, 95%CI 0.41 to 0.95), CG plus CDDP plus MMC significantly reduced mortality after operation during ≥5 years follow up, compared with CG alone (the pooled OR 0.45, 95%CI 0.28 to 0.74), but this effect was not seen during lt; 5 years follow up (OR 0.29, 95%CI 0.08 to 1.15). ③ Side effects were reported in only one study and no significant difference was found between the two groups (P=0.96).
Conclusions Because of the small number of included studies, the lower methodological quality, and the differences in diagnostic criteria of peritoneal recurrence after operation, the reviewers feel that no firm conclusion could be drawn. Some well designed RCTs of CHPP for advancing gastric cancer should be undertaken to further evaluate its effectiveness.
Citation： QIU Jian,LI Guowei,WANG Xiaoqiang,YAN Likun. Prophylactic Chemohyperthermic Peritoneal Perfusion during Radical Operation of Gastric Cancer for Advancing Gastric Cancer:A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2004, 04(12): 859-863. doi: Copy