Clinical research of intraperitoneal implantation of sustained-release 5-fluorouracil in advanced colorectal cancer

Abstract

BackgroundThe objective of this study was to investigate the safety and long-term clinical effect of intraperitoneal implantation of sustained-release 5-fluorouracil in patients with advanced colorectal cancer during radical resection.MethodsA total of 202 patients with advanced colorectal cancer undergoing radical operations were randomly divided into an experimental group (98 cases, intraoperative intraperitoneal implantation of sustained-release 5-fluorouracil 600 mg as local chemotherapy) and a control group (104 cases, without local chemotherapy). The clinical data of the two groups was compared including toxicity, complications, local recurrence rate, distant metastasis, disease-free survival, and 1-, 3-, and 5-year survival rates.ResultsBoth groups of patients were followed up for more than 5 years, the longest follow-up time was 7.5 years. Bone marrow suppression, hepato-renal function, postoperative anastomotic leakage, pelvic effusion, incision infection, the incidence of intestinal obstruction, venting time, and hospital stay after operation (days) between two groups had no statistical significant difference. Locoregional recurrence and liver metastasis rate were decreased significantly in experimental group (P = 0.04 and 0.04). Extensive peritoneal metastasis and other organ metastasis rates had no significant difference between two groups. In the experimental group, 1-, 3-, and 5-year survival rates were higher than in the control group (95.92 vs 87.50 %, 77.55 vs 64.42 %, and 56.12 vs 40.38 %), which had significant difference. Disease-free survival (DFS) of the experimental group was higher than that of the control group (χ2 = 5.00, P = 0.025).ConclusionsIntraperitoneal implantation of sustained-release 5-fluorouracil is safe for advanced colorectal cancer during radical resection, which can reduce locoregional recurrence rate and liver metastasis rate. The long-term efficacy was reliable, and long-term survival and disease-free survival rate can be improved.

A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma

“…It is conducted by placing antitumor agents into the pelvic cavity to eradicate the resid-ual cancer cells at the end of the operation. Previous reports have confirmed that this emerging treatment modality can improve the oncologic prognosis of patients with rectal carcinoma, but its impacts on postoperative AL remain controversial [26]. Our study presented a higher proportion of patients exposed to intraoperative chemotherapy in AL patients than in non-AL patients (66.7% in the AL group versus 33.3% in the non-AL group), which was a significant difference in both the univariate and multivariate analyses This implies that intraoperative chemotherapy might be a risk factor for postoperative AL in rectal surgery.…”

Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

“…Few reports have focused on the use of intraoperative intraperitoneal chemotherapy without hyperthermia to prevent peritoneal carcinomatosis in rectal cancer patients. Intraoperative intraperitoneal chemotherapy is an emerging modality that can improve the prognosis of rectal cancer patients with a high risk of cancer recurrence, and represents a distinct approach from both preoperative chemoradiotherapy and HIPEC that can be easily administrated in the clinic[5,6].…”

“…Previous studies have shown that residual tumor cells can exhibit a transient period of increased growth rate and become more vulnerable to chemotherapeutic agents during the first 3 d following the resection of a primary tumor, which provides the rationale for the administration of intraoperative intraperitoneal chemotherapy to decrease the incidence of peritoneal recurrence[7,8]. Over the past few years, intraoperative intraperitoneal chemotherapy has been gradually incorporated into the treatment for rectal carcinoma patients in Eastern countries[5,6]. Locally advanced rectal carcinoma has a higher risk of peritoneal recurrence, and as a result, clinical stages T3/T4 and N1/N2 of the disease are often regarded as indications for the use of intraoperative intraperitoneal chemotherapy.…”

“…Common drug options include fluorouracil implants, lobaplatin, and raltitrexed. Reports have shown that intraoperative intraperitoneal chemotherapy can reduce locoregional recurrence rates and increase long-term survival rates[5]. Nevertheless, the effects of intraoperative intraperitoneal chemotherapy on postoperative complications have rarely been explored, which raises concerns about the safety and feasibility of this new treatment modality.…”

Fabrication and characterization of 5-Fu loaded poly(lactide-Co-Glycolide) millirods

“…In addition, this study showed that patients receiving continuous infusions of 5-FU suffered less hematological toxicity than patients receiving multiple bolus 5-FU administrations. Since sustained delivery of 5-FU improves efficacy and reduces the toxicity of 5-FU, sustained release 5-FU delivery systems have been heavily investigated (78)(79)(80)(81)(82)(83).…”