A Meta-analysis Of Efficacy And Safety Of Prophylactic Hyperthermic Intraperitoneal Chemotherapy Combined With Intravenous Chemotherapy For Locally Advanced Gastric Cancer

BackgroundGastric cancer is a common malignant tumor with poor prognosis and serious impact on human health.Locally advanced gastric cancer is mainly treated by surgery,but it is easy to relapse after surgery.It was found that prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)combined with intravenous chemotherapy(IC)after radical resection of locally advanced gastric cancer could reduce postoperative recurrence rate and improve long-term survival rate of patients.However,it is still controversial whether HIPEC should be routinely performed after advanced gastric cancer surgery.Therefore,based on existing domestic and foreign studies,this study systematically evaluated whether prophylactic HIPEC combined with IC can reduce postoperative recurrence rate and improve long-term survival rate,and evaluated the safety of prophylactic HIPEC.ObjectTo systematically evaluate the efficacy and safety of prophylactic HIPEC combined with IC for locally advanced gastric cancer.MethodsComputerized retrieval of PubMed,Embase,Cochrance Library,CNKI,CBM and Wanfang databases,collected from the self-built database to 2021-06-30 clinical randomized controlled studies on the application of prophylactic HPIEC combined with IC versus single IC after radical resection of locally advanced gastric cancer.The literatures were screened,excluded and included according to inclusion and exclusion criteria,and the Cochrane Bias risk assessment tool in Cochrane Manual 5.1.0 was used to evaluate the quality of the included studies.After data integration,Meta-analysis was performed on relevant data using Revman5.2 software.The postoperative survival rate,recurrence rate,incidence of complications and adverse reactions were compared between the two groups,so as to evaluate the efficacy and safety of prophylactic HIPEC combined with IC in patients with locally advanced gastric cancer.ResultsA total of 23 RCTs were included,including 2496 patients,1282 in the experimental group and 1214 in the control group.Meta-analysis results:(1)Efficacy evaluation:The 1-year,2-year,3-year and 5-year survival rates of the experimental group were higher than those of the control group,with statistically significant differences,and the OR and 95%CI were:1-year,2-year,3-year and 5-year survival rates:(1.80,1.28～2.55),(2.29,1.65～3.20),(2.51,2.12～2.98)and(3.20,2.50～4.10)。The 1-year recurrence rate of the experimental group was lower than that of the control group,and the difference was not statistically significant(P=0.18>0.05),and the OR and 95%CI were 0.64,0.33～1.23.The recurrence rate of 2,3 and 5 years in the experimental group was lower than that in the control group,and the difference was statistically significant.The OR and 95%CI were:recurrence rate of 2,3 and 5 years:(0.22,0.15～0.33),(0.25,0.16～0.41)and(0.23,0.13～0.42),respectively.(2)Safety evaluation:In terms of complications,the incidence of abdominal pain and abdominal distension in the experimental group was higher than that in the control group,and the difference was statistically significant.There was no significant difference in the incidence of intestinal obstruction,incision infection and anastomotic fistula between the experimental group and the control group.In terms of adverse reactions,there was no significant difference in the incidence of nausea and vomiting,leukopenia,thrombocytopenia,liver function damage,renal function damage and neurotoxicity between the experimental group and the control group.ConclusionCompared with IC alone,prophylactic HIPEC combined with IC can improve the postoperative survival rate of locally advanced gastric cancer,reduce postoperative recurrence rate,and do not increase incidence of postoperative complications and adverse reactions.