Effectiveness And Safety Of Sustained-Release Fluorouracil For Gastric Cancer: A Meta Analysis

Objective: A greate number of gastric carcinoma has transformed into progressive gastric carcinoma when diagnosed if people have some clinical sympotoms,however,effectiveness of operation has significant relationship with whether the cancer exists peritoneum scaling,implantation and metastasis.Intraperitoneal interstitial implant with sustained release fluorouracil during operation has been widely used and got some progress in gastric carcinoma recently,which will be a novel treatment of gastrocolic carcinoma.Our reaserch was designed to invetigate the therapeutic effect and safty of gastric cancer with Intraperitoneal interstitial implant with sustained release fluorouracil,which gives some direction to the cilinical use of drug.Methods: The author searched the database of PubMed,EMbase,The Cochrane Library,CBM,CNKI,VIP and wanfang et al and found related Randomized Control Trial(RCTs)or semi-RCTs of gastric cancer with Intraperitoneal interstitial implant with sustained release fluorouracil and standard operation from february,2007 to february 2017.Then evaluated the quality of included studies using evidence based medicine evaluation criteria and got data;short-term effects(gastrointestinal reaction,the recovery time of gastrointestinal function,seroma volume of drainage after surgery,hospital stay,body temperature recovery time)complications(peritonitis,intraperitoneal abscess,infection of incisional wound,anastomotic fistula,intestinal obstruction)and long-term effects(pstoperative 1 year and 2 year and 3 year survival rate,1 year and 2 year and 3 year recurrence rate)et al were used as outcome indicators.Using review Manage 5.3 to conduct meta analysis and calculate odds ratio(or)among groups,weighted mean difference(WMD)and 95% confidence interval(CI).Funnel plots was made as to conduct bias analysis.Results: The author found 591 related articles and 22 were included in our analysis according to our criteria,which consisted of 2071 patients :1034 patients were treated with intraperitoneal interstitial implant with sustained release fluorouracil and 1037 patients were control group or combined placebo group(normal saline NS).The results indicated that the occurrence of gastrointestinal reaction.Between two groups showed no difference(75% VS 510%,P=0.17).Although the experimental group had longer recovery time of gastrointestinal function [WMD=0.39,95%CI(0.17,0.61),P=0.0004] and Body temperature recovery time [WMD=2.37,95%CI(0.36,4.38),P= 0.02],more seroma volume of drainage after surgery [WMD=37.06,95%CI(15.12,58.99),P=0.0009],it had less hospital stay [WMD=-0.36,95% CI(-0.66,-0.07),P=0.02].However,incidence of pritonitis(58% VS 302%,P=0.5),intraperitoneal abscess(46% VS 325%,P=0.68),infection of incisional wound(77% VS 224%,P=0.32),anastomotic fistula(58% VS 236%,P=0.65),intestinal obstruction(60% VS 219%,P=0.68)displayed no significant difference between them.Compared with control group,experimental group had longer survival rate: pstoperative 1 year survival rate(143% VS 390%,P=0.0008),2year survival rate(158% VS 377%,P=0.0001)and 3year survival rate(197% VS 349%,P=0.00001),and much less recurrence: 1 year recurrence rate(25% VS 66%,P=0.0003)and 2year recurrence rate(17% VS 48%,P=0.00001),and 3 year(29% VS 63%,P<0.0001)recurrence rate.Conclusion: Compared with solo operation,despite of no advantage in short term effects,the fluorouracil implants can shorten the length in hospital and not increase the complications,promote long-term survival rate and reduce recurrence,adding to the convenience of operation,which can be recommended to the clinicl use.