Catheter-related
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link.com/ChineseJournalofCancerResearch19(3).'222—226,2007 Catheter-relatedComplicationsin ChemotherapyforGastricCancer PostoperativeIntraperit0neal XUESheng—liu(薛圣留),HUMei—long(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:Catheter—relatedcomplicationswereseenin10
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,withalowcatheter—relatedcomplicationrate,
shouldberecommendedformoreclinicuse.
Keywords:GastricCancer;IntraperitOneaIchemotherapy;CatheterizatiOn;Centralvenous;Complication
Gastriccanceristhefourthmostcommon
cancerworldwide,withanestimated934,000new
casesintheyearof2002.Itisthesecondmost
commoncauseofdeathfromcancer【.Theonly
potentiallycurativetreatmentforgastriccanceris completesurgicalresection.However.thelong termresultsforrespectablegastriccancerarestill poor.Morethan50%ofthepatientswi】1deve1op
localrecurrenceandmetastasiswithin5yearsafter surgerY.Theresectionsite.peritonealsurfaceand liverarethemostcommonsitesofrecurrenceand metastasis'.RecentlY.IPCThasbecomeoneof hotspotsofgastriccancerresearch.ManYstudies havedemonstratedthatIPCTiseffectivein reducingrecurrenceandmetastasisinsites above—mentionedandinimprovin2survivalj. Somecatheter.relatedcomplicationshavebeen reportedbyusingTenckhoffcathetersandother cathetersystemsinIPCT'.Inthisarticle.80 patientswithgastriccancerinourdepartment receivedpOstOperativeIPCTusingCVCs.Wenow reportourexperiencewithcatheter—related
Received:Jun.23,2007;Accepted:Aug.8,2007 术Authortowhomc0rresp0ndenceshouldbeaddressed E—mail: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 intotheperitonealcavityabout10—15cm
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 forIPCTwas1500—2000m1.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):222—226,2007 community.Recently.IPCThasbecomeoneofthe
hotspotsofgastriccancerresearchandgained wideracceptance.Manystudieshaverevealedthat IPCThasseveralpharmacokineticadvantagesthat cannotbeachievedwithsystemicchemotherapy, includinghighintraperitOnea1concentrations, prolongedtumorexposure,penetrationcapacityof thechemotherapeuticdrugs.1imitedsystemic uptakeandhighdrugconcentrationinportalvein14 IPCTcaneradicatefreecancercellsand
micrometastaticormicroscopicresidua1focusin theperitonealcavityandreducerecurrenceand metastasis[引.
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 r0.40—0.65).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