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Catheter-related

    Catheter-related

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    link.com/ChineseJournalofCancerResearch19(3).'222226,2007 Catheter-relatedComplicationsin ChemotherapyforGastricCancer PostoperativeIntraperit0neal XUEShengliu(薛圣留),HUMeilong(胡美龙)

    DepartmentofRadiationOncology,theFirstAffiliatedHospital,WenzhouMedicalCollege Wenzhou325000

    CLCnumber:R735.2Documentcode:AArticleID:1000.9604(2007)03.0222.05 ABSTRACT

    Objective:Toanalyzecatheter

    relatedcomplicationsduringpostoperativeIntraperitonealchemotherapy(IPCT) forgastrlccancer.Methods:FromDecember2003toApril2007,

    80patientswithgastriccancerweretreated

    withpostoperativeIPCTusingcentralvenouscatheters(CVCs),duringwhichthecomplicationsthatoccurredin

    assoclatlonwithCVCsweredocumentedandanalyzed.

    Results:Catheterrelatedcomplicationswereseenin10

    outofthe8Opatients,yieldingatotalcomplicationrateof12.5%.Maincomplicationsincludedabdominalpain

    (3.8%),localinfection(1.3%),catheterobstruction(2.5%),leakage(2.5%)anddislocation(2.

    5%).Allpatients

    successfullyfinishedtheirIPCT,thesuccessratewas100%.Thereoccurrednoseverecomplicati0nsor

    treatment

    relateddeaths.Conclusion:ItisconvenientandsafetocarryoutpostoperativeIPCTforgastriccancer

    usingCVCs,which,withalowcatheterrelatedcomplicationrate,

    shouldberecommendedformoreclinicuse.

    Keywords:GastricCancer;IntraperitOneaIchemotherapy;CatheterizatiOn;Centralvenous;Complication

    Gastriccanceristhefourthmostcommon

    cancerworldwide,withanestimated934,000new

    casesintheyearof2002.Itisthesecondmost

commoncauseofdeathfromcancer.Theonly

    potentiallycurativetreatmentforgastriccanceris completesurgicalresection.However.thelong termresultsforrespectablegastriccancerarestill poor.Morethan50%ofthepatientswi1deve1op

    localrecurrenceandmetastasiswithin5yearsafter surgerY.Theresectionsite.peritonealsurfaceand liverarethemostcommonsitesofrecurrenceand metastasis'.RecentlY.IPCThasbecomeoneof hotspotsofgastriccancerresearch.ManYstudies havedemonstratedthatIPCTiseffectivein reducingrecurrenceandmetastasisinsites abovementionedandinimprovin2survivalj. Somecatheter.relatedcomplicationshavebeen reportedbyusingTenckhoffcathetersandother cathetersystemsinIPCT'.Inthisarticle.80 patientswithgastriccancerinourdepartment receivedpOstOperativeIPCTusingCVCs.Wenow reportourexperiencewithcatheterrelated

    Received:Jun.23,2007;Accepted:Aug.8,2007 Authortowhomc0rresp0ndenceshouldbeaddressed Email:xueshengliu@163.com

    complicationsofpostoperativeIPCTforgastric cancerasfollows.

    Patients

    MATERIALSANDMETHoDS

    FromDecember2003toApril2007,80patients withgastriccancerinourdepartmentreceived postoperativeIPCT.Asconfirmedbypostoperative pathologYallpatientshasserosalinvasionwithor

    without1ymphnodemetastasis.Therewere52 malesand28femalesagedbetween36to76y (median55),including12stageII,48stageIIIA. 16stareIIIBand4stareIV.

    PeritonealCatheterizati0n

    AsinglecavityCVCfproducedbyArrow

    RaulersonSyringLtdUSA1,3Mtransparent protectingpatchesandheparincap(producedby3 MHealthCareLtdUSA1wereusedinperitoneal catheterization.BilateralMcBurney'spointwas chosenasthepuncturesite.Aftertheabdomenwas preparedwithantisepticsandcoveredwithsterile

www.springerlink.com/ChineseJournalofCancerResearch19(3):222.226,2007223

    drapes,2%lidocainewasusedforlocalanesthesia. Thenaconductingneedlewaspuncturedintothe peritonealcavityobliquely.Afterasteelstringwas putintotheperitonealcavitythroughthe conductingneedleabout30cminlangth.the needlewastakenoutandtheCVCwasinserted intotheperitonealcavityabout1015cm

    followingthesteelstringaftertheabdominalwall wasdilated.Then100mlnormalsalinewas administratedthroughthecatheterrapidlyafter takingoutthesteelstring.Ifnodiscomfortswere observed,aheparincapwasputonthetopofthe catheterandthecatheterwasfixedtothe abdominalwallby3Mtransparentprotecting patches.

    IntraperitOnealChemotherapy

    IPCTwasgiyen2-4weeksaftersurgerV.and wasrepeatedevery4weeks.A11patientsreceived intravenousoxaliPlatin100monday1plusCF 200mgondayltoday5plus5.FU450mg/mon

    day1today3,andintraperitoneal5.FU600/mon day4today5plusDDP40mg/monday5.Before IPCT100mlnormalsalinewith10mDXMwas

    instilledintotheperitonealcavity,5.FUandDDP wasdissolvedin1000mland500mlnormalsaline respectively.andanother500mlnormalsalinewas instilledintotheperitonealcavityfollowinthe chemotherapeuticaRents.Thetotalfluidvolume forIPCTwas15002000m1.A11fluidswere

    warmedto37CbyanextracorDorealtransfusion warmerbeforeinstilledrapidlyintotheperitoneal cavitythroughtheCVC.Patientswereaskedto changetheirbodypositionevery15minfor2h afterintraDeritOnealadministration.Duringthe peritonealcatheterizationandIPCT.catheter. relatedcomplicationsweredocumentedand analyzed.TheCVCwastakenoutwithin24hafter theIPCTwascompletedeachcycle.andanewone wasplacedjustpriortothenextadministrationof IPCT.

    RESUL1'S

    Theincidenceofcatheter.relatedcomplications ofIPCTinthisseriesisshowninTab.1.Atotalof 80patientsreceived331cyclesofIPCT,and catheter.relatedcomplicationswereseenin10Of them.withatotalcomplicationrate12.5%(1o/8o).

    Al1patientssuccessfullyfinishedtheirIPCT,the successratewas100%.Threepatientsoutofthe80 f3.8%)hadmildtomoderateabdominalpain, whichwasrelievedaftercatheterswerepulledout partlyintwopatients,andtheotheronebecame betterafter50mgofindomethacinsuppositories wasgivenrectally.One(1.3%)patientexperienced rednessaroundtheinsertionsitewhichwas suspectedaslocalinfection,andafterbeing sterilizedbypovidoneiodinedaily,becamebetter aftertheremovalofthecatheterattheendofIPCT. Two(2.5%)patientshadcatheterobstruction.one ofthemgotrecanalizationafterflushedby Heparinizednormalsaline.andtheotherhadthe catheterremovedandanewcatheterreplacedon theoppositeside.Two(2.5%)patientsexperienced leakageattheinsertionsite,andweredealtwith gelatinspongestriplocally,bothfinishedtheir IPCTsuccessfully.Two(2.5%1patients

    experiencedcatheterdislocationandhadthe cathetersreplacedontheoppositeside.Nosevere complicationSandtreatment.relateddeathswere observed

    Tab.J.Catheter-relatedcomplicationsof IPCTusingCVCs

    ComplicationsNumberofpatients(%)

    Abdominalpain

    Infection

    Obstruction

    Leakage

Dislocation

    Tota1

    3(3.8%)

    1(1.3%)

    2(2.5%)

    2(2.5%)

    2(2.5%)

    10(12.5%)

    DISCUSSION

    InJapanandwesterncountries.thecurative resectionratesforgastriccancerare58.6%and 17.8%respectivelv.Morethan50%ofpatients whohaveundergonecurativeresectionincluding extendedlymphadectomydeveloplocoregional recurrenceandmetastasisin1-3YaftersurgerV. andthe5.yearsurvivalratesareonly60.5%and 39.4%.respectively.Theresectionsite,peritoneal surfaceandliverarethemostcommonsitesof recurrenceandrelapse.Thesestatisticssuggest thatsurgeryaloneisnotanadequatetreatmentfor gastriccancer".

    Analysishasshownthatserosalinvasionand lymphnodemetastasisareriskfactorsforall recurrencepatternsandearlyrecurrenceand metastasis.Howtoreduceandpreventthe

    recurrenceandmetastasisisanimportantand troublesomeissueingastriccancerresearch

    224www.springerlink.corn/ChineseJournalofCancerResearch19(3):222226,2007 community.Recently.IPCThasbecomeoneofthe

    hotspotsofgastriccancerresearchandgained wideracceptance.Manystudieshaverevealedthat IPCThasseveralpharmacokineticadvantagesthat cannotbeachievedwithsystemicchemotherapy, includinghighintraperitOnea1concentrations, prolongedtumorexposure,penetrationcapacityof thechemotherapeuticdrugs.1imitedsystemic uptakeandhighdrugconcentrationinportalvein14 IPCTcaneradicatefreecancercellsand

    micrometastaticormicroscopicresidua1focusin theperitonealcavityandreducerecurrenceand metastasis[.

    Manyclinicalstudieshavestronglysuggested thatthepOstOperativeIPCTcanimproveoverall survivalorhasatrendtowardsanincreasein overallsurvival[,-.InaphaseIIIclinicalstudv bvYueta1.'91.248patientswithgastriccancer whohadundergoneR0curativeresectionwere randomizedtoIPCTgroup(125cases)andsurgery alonegroupf123cases),andastatistically significantsurvivaladvantagewasseeninthe IPCTgroup.The5.yearsurvivalrateswere54% and38%(P=0.0278),respectively.Subgroup analysisofthisstudyindicatedthatcomparedwith thosewhoreceivedsurgeryalone,thosepatients whohadserosalinvasionf52%and25%,

    respectively;P=0.0004),orwithlymphaticnode metastasis(46%and22%.respectively;P=0.0027) benefitedmorefrompOstOperativeIPCT.The authorsconcludedthatserosalinvasionwithor

    without1ymphnodemetastasiscanbeusedasthe maiorselectioncriteriaforpostoperativeIPCTfor gastriccancer.Additionally,studiesbyHamazoeet a1..fP=0.

    02)andFujimotoeta1.(P=O.0362)

    bothshowedastatisticallysignificantdatafora 5.yearsurvivalrate.AndFujimuraeta1.showed astatisticallysignificantimprovementof3.year survivalratefortheIPCTgroup(P=0.01).Recently, Xueta1.i1performedameta.analysisofIPCTfor gastriccancer,inwhicheleventrialsinvolving 1161caseswereincluded.ThepooledoddsratioOf IPCTwas0.51.witha95%confidenceinterval r0.400.65).TheypointedoutthatIPCTafter curativeresectionforlocallyadvancedgastric cancermaybebeneficialtopatients.A11these studieshavedemonstratedthatpostoperativeIPCT isarationalandeffectivetherapeuticmodalityfor gastriccancerpatientsathighriskforrecurrence andmetastasis.Inthisarticle,ourpatientsallhad serosa1invasionwithorwithoutlymphnode metastasis,whichmatchestheselectioncriteria recommendedbyYueta1..

    Actually,thetechnologyandemploymentof postoperativeIPCTforgastriccancerarealmost thesameasthatforovariancancerexceptfor chemotherapeuticregimenS.Someperitoneal accessdevicesmustbeusedinIPCTforboth gastricandovariancancer.whichismoredifficult andcomplicatedthansystemicchemotherapyand

    hasahighercomplicationrate.Catheter.related complicationisoneofthemajorreasonsforfailure OfIPCT.Commonlyreportedcomplicationsrelated totheperitonealaccessdevicesincludefailureto placecatheterssuccessfully,infection,abdominal pain,bowelperforation,adhesiveileus, malfunctionsofcatheter(obstructionand1eakage), andrarelybleedingandintraabdominalabscess. Differentdevicesinvolvingtheadministrationof IPCTmaycausedifferentcatheter.related complications.Butnorandomizedtrialshave differentiatedthesuperiorityofonesystemover anotherL141.Inalatestintergroupintraperitonea1 tria1.34%opatientsdiscontinuedIPCTdueto catheter.specificcomplicationsIJ.Tenchkoff catheters,Port.A.Cathsystems,implanted subcutaneOusportcathetersfi.e.,Bardport catheter),CVCs,single.usepunctureneedlesand thetrocarsystemsarethecommonlyuseddevices inIPCT.TenchkoffcathetersandPort.A.Cath systemswereemployedearlierthantheother devicesinIPCT,ofwhichthe'major

    catheter.relatedcomplicationsincludedinfecfion andbowelperforationwithacomplicationrate rangingfrom11.5%to50%.Sakuragieta1.10 reportedthat78patientsweretreatedwithatotal of365coursesofpOstOperativeIPCTusing Tenckhoffcatheters.Amongthem,39(50%) experiencedcatheter.relatedcomplications.17 f21.8%1hadextensiveintraabdominaladhesion,13

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