In the bag.

Peritoneal mets are a big problem in locally-advanced gastric cancer. Peritoneal chemo was a fad at various centers throughout the past few decades, but objective data never really panned out. Another idea is peritoneal lavage, where the surgeons literally clean out floating tumor cells from the peritoneum at the time of surgery before they ever have a chance to make a home on the mucosal lining (think: wound irrigation of bacteria). The Chinese phase 3 SEIPLUS trial randomized 550 patients undergoing D2 gastrectomy for T3-4 gastric cancer to +/- peritoneal lavage at time of surgery. All received adjuvant chemo with 5FU and oxaliplatin. On study, peritoneal lavage consisted of 1 L of normal saline stirred throughout the peritoneum and then completely aspirated 10x over, or just long enough for an intern to do it while the attending grabs lunch. While the primary endpoint of overall survival is still maturing, here we learn the lavage arm enjoyed significantly reduced rates of post-op complications (including abdominal infection), pain, and even 30-day mortality. Those interns must have been doing something right. TBL: Peritoneal lavage is a cheap and effective way to prevent gastrectomy complications and may even pan out to help maximize gastric cancer control. | Guo, JAMA Surg 2019