Gastric Cancer
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2005; 11(31): 4776-4781
Published online Aug 21, 2005. doi: 10.3748/wjg.v11.i31.4776
Preventing prolonged post-operative ileus in gastric cancer patients undergoing gastrectomy and intra-peritoneal chemotherapy
De-Chuan Chan, Yao-Chi Liu, Cheng-Jueng Chen, Jyh-Cherng Yu, Heng-Cheng Chu, Fa-Chang Chen, Teng-Wei Chen, Huan-Fa Hsieh, Tzu-Ming Chang, Kuo-Liang Shen
De-Chuan Chan, Yao-Chi Liu, Cheng-Jueng Chen, Jyh-Cherng Yu, Teng-Wei Chen, Kuo-Liang Shen, Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, National Defense University, Taipei, Taiwan, China
Heng-Cheng Chu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, National Defense University, Taipei, Taiwan, China
Fa-Chang Chen, Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, National Defense University, Taipei, Taiwan, China
Huan-Fa Hsieh, Yee-Zen General Hospital, Taoyuan, Taiwan, China
Tzu-Ming Chang, Department of Surgery, Shalu Tungs’ Memorial Hospital, Tai-Chung, Taiwan, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. De-Chuan Chan, Division of General Surgery, National Defense Medical Center, National Defense University, Taipei 114, Taiwan, China. chrischan1168@yahoo.com.tw
Telephone: +886-2-87927191 Fax: +886-2-87927372
Received: January 1, 2005
Revised: January 23, 2005
Accepted: January 26, 2005
Published online: August 21, 2005
Abstract

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 soft 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 vs group 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 significantly shorter 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.

Keywords: Metoclopramide; C-reactive protein; Gastric cancer; Intraperitoneal chemotherapy