| BackgroundIn China,the majority of patients with gastric cancer have been diagnosed with advanced stage,even after radical surgery,the majority of patients still have local recurrence or distant metastasis due to peritoneal exfoliated cancer cells,the prognosis is poor.Therefore,it is the key factor to affect the survival rate of patients with gastric cancer by how to effectively remove the tumor cells in the abdominal cavity and the minimal residual cancer foci.In order to prevent gastric cancer peritoneal metastasis or recurrence,improve the prognosis of advanced gastric cancer patients in our hospital,the patients with advanced gastric cancer were treated with comprehensive therapy of intravenous chemotherapy resection combined with intraoperative accurate treatment,intra-operative precise hyperthermic intraperitoneal chemotherapy.To explore the clinical efficacy of the treatment technology is conducive to promoting the healthy development of the technology to promote the clinical application of this technology,so that more patients with gastric cancer benefit.ObjectiveTo observe the difference of the effect of intra-operative precise hyperthermic intraperitoneal chemotherapy combined with postoperative intravenous chemotherapy and postoperative conventional intravenous chemotherapy in the treatment of advanced gastric cancer,objective to investigate the safety and efficacy of precise hyperthermic intraperitoneal chemotherapy.MethodsClinical data of 96 patients with advanced gastric cancer were from general surgery of Nanyang Central Hospital from March 2012 to February 2013,these patients have been confirmed by pathology and underwent standard D2 radical resection of gastric cancer.According to the different treatment methods,47 patients were assigned to the operation of precise hyperthermic intraperitoneal chemotherapy as the study group,while only routine peritoneal lavage was performed in the control group(n = 49),two groups of patients were treated with systemic intravenous chemotherapy according to the mFOLFOX6 regimen at 3-4 weeks after operation.The clinical data of two groups were analyzed,and the incidence of adverse reactions,quality of life,complication rate,the local recurrence rate?distant metastasis rate and survival rate of the 3 years were compared between the two groups.The adverse reactions included two groups of patients with blood routine? liver function and other abnormal blood parameters,and body temperature?blood pressure and other clinical indicators of abnormal when they did not receive intravenous chemotherapy after operation,and bone marrow suppression?gastrointestinal reactions and other toxic reactions after intravenous chemotherapy,quality of life assessment reference standard for evaluation of KPS,complications including anastomotic fistula and incision infection? pulmonary infection?intestinal obstruction.ResultsThere was no significant difference in the incidence of adverse reactions between the study group and the control group(P > 0.05).Comparing the two groups of patients with postoperative quality of life score,the total effective rate of the study group was 80.9%,higher than that of the control group(61.2%),the data were statistically analyzed,the difference was statistically significant(P < 0.05).The anastomotic leakage ?incidence of incision infection? intra-abdominal infection and pulmonary infection in the study group was 4.3%?4.3%?6.4%?8.5%,lower than that in the control group(8.2%?6.1%?8.2%? 12.2%),the difference was not statistically significant(P > 0.05);the study group patients with postoperative intestinal obstruction incidence rate was12.8%,lower than the control group(30.6%),the difference was statistically significant(P < 0.05).The local recurrence rate and distant metastasis rate of the study group was 10.6%?12.8%,lower than that of the control group in 3 years(28.6% ?34.7%),the 3 years survival rate of the study group was 68.1%,higher than that of the control group(46.9%),the data were statistically analyzed,the difference was statistically significant(P < 0.05).Conclusion1.In the treatment of advanced gastric cancer patients after D2 radical operation,intra-operative precise hyperthermic intraperitoneal chemotherapy combined with postoperative intravenous chemotherap compared with postoperative systemic intravenous chemotherapy can significantly improve the quality of life of patients after operation.2.Intra-operative precise hyperthermic intraperitoneal chemotherapy is safe and feasible,which can reduce the incidence of postoperative intestinal obstruction complications,and does not increase the incidence of adverse reactions and postoperative complications such as anastomotic leakage?incision infection? intra-abdominal infection and pulmonary infection.3.Intra-operative precise hyperthermic intraperitoneal chemotherapy combined with postoperative intravenous chemotherap could improve patients with advanced gastric cancer after 3 years of survival rate,reduce the local recurrence rate and distant metastasis rate of 3 years after operation,and prevent postoperative peritoneal recurrence and distant metastasis. |
PDF Full Text Request