Preventing prolonged post-operative ileus in gastric cancer patients undergoing gastrectomy and intra-peritoneal chemotherapy

AIM： To assess the efficacy of metoclopramide （Met） for prevention of prolonged post-operative ileus in advanced gastric cancer patients undergoing D2 gastrectomy and intra-peritoneal chemotherapy （IPC）. METHODS： Thirty-two advanced gastric cancer patients undergoing D2 gastrectomy and IPC were allo...

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Published in:World journal of gastroenterology : WJG 2005-08, Vol.11 (31), p.4776-4781
Main Authors: Chan, De-Chuan, Liu, Yao-Chi, Chen, Cheng-Jueng, Yu, Jyh-Cherng, Chu, Heng-Cheng, Chen, Fa-Chang, Chen, Teng-Wei, Hsieh, Huan-Fa, Chang, Tzu-Ming, Shen, Kuo-Liang
Format: Article
Language:English
Subjects:
Adult
Aged
Dopamine Antagonists - therapeutic use
Electrolytes - blood
Female
Gastrectomy - adverse effects
Gastric Cancer
Humans
Ileus - prevention & control
Male
Metoclopramide - therapeutic use
Middle Aged
Pain, Postoperative
Postoperative Complications - prevention & control
Stomach Neoplasms - surgery
化学疗法
手术治疗
肠梗阻
胃切除术
胃复安
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Summary:AIM： To assess the efficacy of metoclopramide （Met） for prevention of prolonged post-operative ileus in advanced gastric cancer patients undergoing D2 gastrectomy and intra-peritoneal chemotherapy （IPC）. METHODS： Thirty-two advanced gastric cancer patients undergoing D2 gastrectomy and IPC were allocated to two groups. Sixteen patients received Met immediately after operation （group A）, and 16 did not （group B）. Another 16 patients who underwent D2 gastrectomy without IPC were enrolled as the control group （group C）. All patients had received epidural pain control. The primary endpoints were time to first post-operative flatus and time until oral feeding with a soft diet without discomfort. Secondary endpoints were early complications during hospitalization. RESULTS： Gender, the type of resection, operating time, blood loss, tumor status and amount of narcotics were comparable in the three groups. However, the group C patients were older than those in groups A and B （67.5±17.7 vs 56.8±13.2, 57.5±11.7 years, P= 0.048）. First bowel flatus occurred after 4.35±0.93 d in group A, 4.94±1.37 d in group B, and 4.71±1.22 d in group C （P〉0.05）. Oral feeding of a sore diet was tolerated 7.21±1.92 d after operation in group A, 10.15±2.17 d in group B, and 7.53±1.35 d in group C （groups A and C vsgroup B, P〈0.05）. There was no significant difference in respect to the first flatus among the three groups. However, the time of tolerating oral intake with soft food in groups A and C patients was significantlyshorter than that in group B patients. Levels of C-reactive protein （CRP） were significantly lower in group C and there was a more prominent and prolonged response in CRP level in patients undergoing IPC. The incidence of post-operative complications was similar in the three groups except for prolonged post-operative ileus. There was no increased risk of anastomotic leakage in patients receiving Met. CONCLUSION： The results suggest that a combination of intravenous Met and epidural pain control may be required to achieve a considerable decrease in time to resumption of oral soft diet in advanced gastric cancer patients who underwent gastrectomy and IPC. Furthermore, the administration of Met did not increase anastomotic leakage. Met has a role in the prevention of prolonged post-operative ileus.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v11.i31.4776