Extensive intraoperative peritoneal lavage with surgery, compared to surgery alone, for patients diagnosed with gastric cancer: A systematic review and meta-analysis of randomized controlled trials.

Background: Gastric cancer ranks as the fifth most frequently diagnosed cancer and the seventh most prevalent overall. The lifetime risk of developing gastric cancer is 1.87% for males and 0.79% for females worldwide.

Aim: This systematic review and meta-analysis aimed to determine whether Extensive Intraoperative Peritoneal Lavage (EIPL) provides short-term benefits or improved survival outcomes for patients undergoing gastrectomy.

Methods: A comprehensive search spanned PubMed, Embase, Cochrane Library, clinicaltrials.gov, and Web of Science, from their inception up to October 2023, adhering to predefined inclusion and exclusion criteria. The quality of the studies was analyzed using the Cochrane Collaboration Risk of Bias Tool. Data analysis was done using Review Manager 5.3, utilizing a random-effects model.

Results: Our analysis incorporated seven randomized controlled trials with 2602 patients. The follow-up time for all outcomes varied from 30-60 months. For our primary outcomes, EIPL demonstrated a significant benefit over surgery alone in terms of recurrence (RR=0.73; 95% CI: 0.65 to 0.83, P<0.00001) and postoperative complications (RR=0.67; 95% CI: 0.51 to 0.87, P=0.003). For our secondary outcomes, postoperative hospital stay (MD=-0.35; 95% CI: -1.11 to 0.41; P-value=0.37), 3-year overall survival (OR=1.44; 95% CI 0.84 to 2.47; P-value=0.19), 3-year disease-free survival (HR=0.93; 95% CI: 0.78 to 1.13; P-value=0.48), and time to first flatus (MD=-0.17; 95% CI: -0.35 to 0.01; P-value=0.06), no statistically significant differences were observed between the EIPL and control groups.

Conclusion: While there is a marginal difference in survival outcomes, EIPL holds promise in significantly reducing overall cancer recurrence and suggests an enhancement in postoperative recovery.