To Explore The Value Of Hyperthermic Intraperitoneal Chemotherapy In The Adjuvant Treatment Of Gastric Cancer After Operation

Objective: To compare the efficacy and safety of two adjuvant chemotherapy methods,namely,circulating hyperthermic intraperitoneal chemotherapy combined with systemic chemotherapy and systemic chemotherapy alone,after radical resection of locally advanced gastric cancer,in order to prove the therapeutic advantages of hyperthermic intraperitoneal chemotherapy in the adjuvant treatment of gastric cancer after operation.Methods: From February 2010 to January 2016,82 patients with locally advanced gastric cancer who had undergone radical gastrectomy(D2 lymph node dissection)and whose postoperative pathology was p T4N0-3M0(AJCC stage of the 7th edition was IIB-IIIC stage)were randomly divided into two groups.There were 40 cases in the experimental group and 42 cases in the control group,the experimental group was treated with circulating hyperthermic intraperitoneal chemotherapy combined with systemic chemotherapy,while the control group was treated with systemic chemotherapy alone.Patients were followed up to January 2019,and adverse reactions,time and site of first recurrence or metastasis,as well as the time of death were collected.Graphpad prism 7.0 software was used for statistical analysis to compare the relapse-free survival and total survival of the two groups.SPSS 17.0 statistical software was used to analyze and compare the recurrence rate and incidence of adverse events of the two groups.Results: 1.The logrank test for survival without recurrence in the two groups p=0.0432,indicating a statistical difference.The median relapse-free survival was 32 months in the experimental group and 17 months in the control group.The 2,3 and 5-year recurrence free survival rates were 55%,47.5% and 43.3%,respectively,in the experimental group.The control group was 42.8%,35.7% and 29%.All the relapse-free survival data were significantly improved in the experimental group.Logrank test for total survival of the two groups showed no statistical difference(p=0.2268).The median total survival time was 42 months in the experimental group and 29 months in the control group.The 2-year,3-year and 5-year survival rates in the experimental group were 67.5%,55% and 46.7%,respectively.The control group was 57.1%,45.2% and 35.4%.The results showed that the survival of the experimental group was better than that of the control group.2.There was no difference in local recurrence rate and distant metastasis rate between the two groups,while the peritoneal metastasis rate in the experimental group was significantly lower than that in the control group(p=0.026),showing a statistical difference.3.There was a statistical difference between the two groups in all levels of abdominal pain and abdominal distension(p<0.05),but there was no statistical difference in the severity of grade 3-4.Grade 1-2 abdominal distension events increased in the experimental group due to peritoneal injection of about 3L peritoneal irrigation solution,but it was generally relieved within one week after the absorption of peritoneal irrigation solution,and no intestinal obstruction events caused by treatment were observed.Except grade 1-2 abdominal pain and abdominal distension,there was no statistical difference in other adverse events between the two groups,among which nausea and vomiting and hematological toxicity showed a decreasing trend in the experimental group.Conclusion: Compared with systemic chemotherapy alone,the adjuvant application of circulating hyperthermic intraperitoneal chemotherapy combined with systemic chemotherapy after radical resection of locally advanced gastric cancer can reduce the rate of peritoneal metastasis,improve the survival without recurrence,and have an improving trend of overall survival.The incidence of complications caused by circulating hyperthermic intraperitoneal chemotherapy is within the acceptable range.This experiment preliminarily proved the adjuvant treatment value of circulating hyperthermic intraperitoneal chemotherapy after radical resection of locally advanced gastric cancer,so this technique is worthy of further study.