Objective To evaluate the effectiveness and safety of implanted sustained-release fluorouracil in gastric cancer surgery. Methods Literature search was conducted in the following databases: PubMed, EMbase, The Cochrane Library (Issue 6, 2012), CNKI, VIP and WanFang Data from inception to June, 2012. Randomized controlled trials (RCTs) or quasi-randomized controlled trials on implanted sustained-release fluorouracil for gastric cancer were included. Two reviewers independently identified the literature according to the inclusion and exclusion criteria, and then extracted the data and assessed the quality of the included studies. Then, meta-analysis was conducted using RevMan 5.1 software. Results A total of 7 studies involving 742 patients were included. The results of meta-analysis showed no significant difference in the rate of postoperative complications between the two groups (OR=0.93, 95%CI 0.54 to 1.59, P=0.79), while a significant reduction was found in the recurrence rate in the sustained-release fluorouracil group during 1 to 3 year follow-up (1 year after surgery: OR=0.32, 95%CI 0.22 to 0.46, P=0.02; 2 years after surgery: OR=0.19, 95%CI 0.08 to 0.42, Plt;0.001; 3 years after surgery: OR=0.40, 95%CI 0.24 to 0.67, P=0.004). As for the survival rate, no significant difference was found between the two groups 1 year after surgery (OR=1.98, 95%CI 0.92 to 4.25, P=0.08), while it was significantly higher in the sustained-release fluorouracil group than in the control group 2 to 3 years after surgery (2 years after surgery: OR=2.63, 95%CI 1.17 to 5.91, P=0.02; 3 years after surgery: OR=2.42, 95%CI 1.53 to 3.83, P=0.002). Adverse reaction rates in the sustained-release fluorouracil group were lower than those in the control group, but without significantly differences between the two groups (OR=1.22, 95%CI 0.49 to 3.07, P=0.67). Conclusion Compared with the control group, implanted sustained-release fluorouracil for gastric cancer can significantly reduce the recurrence rate 1 to 2 years after surgery and improve the overall survival rate 2 to 3 years after surgery without increasing the incidences of the postoperative complications and adverse reaction. However, due to the limitation of quantity and quality of the included studies, this conclusion should be further confirmed by more high quality, larger sample and multi-center RCTs.
Objective To explore the postoperative influence of intra-abdominal implantation of sustained-releasing 5fluorouracil on the hepato-renal function, immune function, nutritional state and complications in patients with gastric and colorectal cancer. Methods Sixty-five patients with gastric or colorectal cancer were included into this study from January to June 2009. The patients (35 cases of gastric cancer, 18 cases of colon cancer and 12 cases of rectal cancer) were randomly divided into experimental group (n=25) and control group (n=40). In experimental group, 400 mg sustained-releasing 5-fluorouracil was used. Blood samples were gained before operation, the second day and the seventh day after operation to examine the indexes of hepato-renal function, immune function and nutritional state. Complications， venting time and length of stay after operation were also recorded. Results There was no statistical significance for distribution of tumor stages and patients’ gender between experimental group and control group (Pgt;0.05). Preoperative indexes of hepato-renal function, immune function and nutritional state were also not reached statistical significance between two groups (Pgt;0.05). Compared with control group, the indexes of total protein and transferrin were decreased and urea nitrogen and IgM were increased in the second day after operation in experimental group (Plt;0.05). The number of lymphocyte was increased, while CD4, Alb, total protein and IgA were decreased in the seventh day after operation in experimental group, respectively. The time of passage of gas of experimental group was longer than that of control group (Plt;0.05).Conclusion Intra-abdominal implantation of sustained-releasing 5-fluorouracil is safe and feasible, which does not increase the complications and the time of length stay after operation. However, there is a little influence on immune function and gastrointestinal function after operation for intra-abdominal implantation of sustained-releasing 5-fluorouracil.
目的观察直肠癌术中局部植入氟尿嘧啶缓释剂（5-FU SRI）的可行性及疗效。 方法92例直肠癌患者分成治疗组和对照组，治疗组术中在瘤床和沿淋巴引流途径分多点植入5-FU SRI 600 mg，对照组行常规直肠癌根治术，观察2组患者的手术情况、毒副反应、近期并发症及远期疗效。 结果2组的手术时间、出血量以及腹膜炎、吻合口漏、肠梗阻和切口感染发生率的差异均无统计学意义（P＞0.05）；2组患者的白细胞计数、肌酐及ALT水平治疗后高于治疗前（P＜0.05），但2组间差异无统计学意义（P＞0.05）。治疗组腹腔局部复发率及远处转移率均较对照组低（P＜0.05）。 结论直肠癌术中植入5-FU SRI是安全可行的，是预防术后复发转移的有效途径。
ObjectiveTo observe effect and safety of interstitial chemotherapy with 5-fluorouracil sustained release agent in radical operation of colorectal cancer. MethodsOne hundred and sixty patients with colorectal cancer from October 2011 to December 2013 were randomly divided into observation group and control group according to an incomplete random method, 78 cases of them were in the observation group and 82 cases of them were in the control group. All the patients were performed radical resection of colorectal cancer. The abdominal cavity and pelvic cavity were washed after surgery. 5-fluorouracil sustained release agent was implanted in the observation group patients for interstitial chemotherapy, the implant site was at the tumor resection area and the mesenteric artery. Routine chemotherapy was performed in these two groups after operation. The postoperative complications were observed. The postoperative local recurrence rate, liver metastasis rate, and 24-month survival rate were recorded. ResultsThe rates of abdominal complications and toxic effects had no significant differences between these two groups (P > 0.05). The rates of 12-month and 24-month local recurrence and the rate of liver metastasis in the observation group were significant lower than those in the control group[1.3% (1/78) versus 8.5% (7/82), x2=8.934, P=0.023; 5.2% (4/78) versus 23.2% (19/82), x2=14.834, P=0.004; 10.3% (8/78) versus 18.3% (15/82), x2=12.034, P=0.016]. The rate of 24-month survival in the observation group was significant higher than that in the control group[94.9% (74/78) versus 84.1% (69/82), x2=11.465, P=0.010]. ConclusionThe good safety of interstitial chemotherapy with 5-fluorouracil sustained release agent could effectively decrease local recurrence rate and liver metastasis rate of colorectal cancer after radical operation and improve survival time of patients.