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Extensive intraoperative peritoneal lavage after gastrectomy for gastric cancer with peritoneal cytology positivityCan washing the belly during surgery help prevent stomach cancer from coming back?

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Key Takeaway
Consider that extensive intraoperative peritoneal lavage may reduce peritoneal recurrence in select gastric cancer patients, but evidence is from a small, single-arm trial with low certainty.

This was a single-arm exploratory phase 2 trial in 13 patients with gastric cancer and positive peritoneal cytology (CY1) and/or stamp cytology positivity. The intervention was extensive intraoperative peritoneal lavage (EIPL) after open gastrectomy in a multi-institutional setting; there was no comparator.

The primary outcome was relapse-free survival (RFS). The median 3-year RFS was 14.5 months (95% CI 5.4-NA). The median 3-year overall survival was not reached (95% CI 14.5-NA). The median 3-year peritoneal RFS was 16.0 months (95% CI 5.4-NA). The 3-year peritoneal RFS rate was 83% in CY0 and stamp+ cases (n=6) versus 0% in CY1 and stamp+/- cases (n=7) (log-rank p=0.015).

Adverse events, serious adverse events, discontinuations, and tolerability were not reported. Key limitations include slow accrual, early trial stop due to lack of applicants (n=13), and inability to evaluate prespecified endpoints thoroughly. Funding and conflicts were not reported.

Practice relevance suggests EIPL might be effective to prevent peritoneal recurrence, especially in CY0 and stamp+ cases. However, this is an exploratory phase 2 trial; causation is not established. Results are from a small, single-arm study with early stop; certainty is low.

If you have stomach cancer that has reached the lining of your belly, the fear of it coming back after surgery is real. This small, early study tested a thorough washing of the belly during surgery, called extensive intraoperative peritoneal lavage (EIPL), to see if it could help.

The study included 13 patients with this type of stomach cancer. After their open surgery, the surgeons washed the belly cavity extensively. The main goal was to see how long patients stayed cancer-free. Over 36 months of follow-up, the median time until the cancer came back was about 14.5 months. For overall survival, the median time was not reached, meaning more than half the patients were still alive at the study's end.

The results showed a notable difference based on the cancer's spread. Patients whose belly washings were clear of cancer cells (CY0) but had positive stamp tests had an 83% rate of staying free from belly recurrence. In contrast, patients with positive washings (CY1) had a 0% rate. However, the study was very small, stopped early due to slow patient enrollment, and had no comparison group. Safety data was not reported.

This is an exploratory trial, so it can't prove the washing causes better outcomes. The findings are promising but very preliminary, and the low certainty means much more research is needed before this could be a standard practice.

What this means for you:
A belly wash during surgery showed early promise for some stomach cancer patients, but the study was too small to be sure.

Study Details

Study typePhase2
Sample sizen = 6
EvidenceLevel 3
Follow-up36.0 mo
PublishedJan 2026
View Original Abstract ↓
BACKGROUND: Our group revealed that the combination of intra-operative stamp cytology and peritoneal lavage cytology (CY) improved the identification of individuals with high risk of peritoneal metastasis. In this exploratory Phase II study, we aimed to evaluate the effect on relapse-free survival (RFS) of extensive intraoperative peritoneal lavage (EIPL) for gastric cancer with positive peritoneal cytology (CY1) and/or stamp cytology positive (stamp+). MATERIALS AND METHODS: This study was a single arm, multi-institutional, exploratory phase 2 trial to assess the effects of EIPL after open gastrectomy for gastric cancer with CY1 and/ or stamp+. The primary endpoint was RFS. Secondary endpoints were overall survival (OS), postoperative recurrence site and incidence of postoperative adverse events. RESULTS: Between 2017 and 2021, 13 patients from 2 institutions were enrolled in this study. Because of the recent decline in open abdominal surgery, the number of cases did not increase and the trial was closed due to lack of applicants at 13 cases. Median 3-year RFS was 14.5 months (95% CI 5.4-NA), median 3-year OS was not reached (95% CI 14.5-NA) and median3-year peritoneal RFS was 16.0 months (95% CI 5.4-NA). Median 3-year peritoneal RFS rate was 83% in CY0 and stamp+ cases (n=6), and 0% in CY1 and stamp+/- cases (n=7). (Log-rank p=0.015). CONCLUSION: Because of the slow accrual pace and early stop of the trial, we were not able to evaluate the prespecified endpoints thoroughly. However, EIPL might be effective to prevent perineal recurrence, especially in CY0 and stamp+ case.
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