Peritoneal carcinomatosis in gastric cancer is considered a fatal disease, without expectation of definitive cure. As systemic chemotherapy is not sufficient to contain the disease, a multimodal approach associating intraperitoneal chemotherapy with surgery may represent an alternative for these cases.
The aim of this study was to investigate the role of intraperitoneal chemotherapy in stage IV gastric cancer patients with peritoneal metastasis.
This study is a single institutional single-arm prospective clinical trial phase II (NCT05541146). Patients with the following inclusion criteria undergo implantation of a peritoneal catheter for intraperitoneal chemotherapy: Stage IV gastric adenocarcinoma; age 18–75 years; Peritoneal carcinomatosis with peritoneal cancer index<12; Eastern Cooperative Oncology Group 0/1; good clinical status; and lab exams within normal limits. The study protocol consists of four cycles of intraperitoneal chemotherapy with paclitaxel associated with systemic chemotherapy. After treatment, patients with peritoneal response assessed by staging laparoscopy undergo conversion gastrectomy.
The primary outcome is the rate of complete peritoneal response. Progression-free and overall survivals are other outcomes evaluated. The study started in July 2022, and patients will be screened for inclusion until 30 are enrolled.
Therapies for advanced gastric cancer patients have been evaluated in clinical trials but without success in patients with peritoneal metastasis. The treatment proposed in this trial can be promising, with easy catheter implantation and ambulatory intraperitoneal chemotherapy regime. Verifying the efficacy and safety of paclitaxel with systemic chemotherapy is an important progress that this study intends to investigate.
The success of peritoneal dialysis depends on the proper placement and functional longevity of the dialysis catheter. Laparoscopic implantation of a catheter through a rectus sheath tunneling can minimize the risks of catheter failure.
This study aims to describe one-port simplified technique for laparoscopic placement of a peritoneal dialysis catheter with rectus sheath tunneling.
The simplified laparoscopic insertion of a Tenckhoff catheter with rectus sheath tunneling was performed in 16 patients with chronic renal failure.
During the follow-up period, no major complications occurred. Three patients were excluded. One was referred to the renal transplant some weeks after implantation, and one died for other reasons during the follow-up. Another patient needed adhesiolysis due to previous surgery, so an additional port was necessary. The other 13 catheters worked properly, and no postoperative hemorrhage, early leaks, hernia, or catheter migration occurred. One patient had a tunnel infection 11 months after the implant. No peritonitis was observed during the follow-up.
The technique is simple, reproducible, and safe, with good results in catheter function, few complications, and a high catheter survival rate. It does not require a special device or trocar and avoids excessive port sites.
Desenvolvido por Surya MKT