Extended intraoperative peritoneal lavage as prophylactic peritoneal recurrence for locally advanced gastric cancer: a prospective randomized trial

BACKGROUND

To demonstrate whether extensive intraoperative peritoneal lavage (EIPL) could yield better results in overall survival and less recurrence, regardless of peritoneal cytology, compared to standard peritoneal lavage (SPL).

METHODS

A prospective randomised multicenter study including 94 patients (47 per arm) to detect a 20% difference in 3-year overall survival in patients with locally advanced tumours without peritoneal carcinomatosis. Three samples of peritoneal fluid were obtained (at the beginning, the end of procedure and after the assigned peritoneal lavage). Clinicopathological and surgical data were analysed by group. Postoperative complications, location of recurrence and surgical approach were evaluated. Overall survival was calculated by the Kaplan-Meier method and the uni/multivariate analysis for prognostic factors was carried out using Cox regression analysis.

RESULTS

A total of 86 patients were analysed (4 excluded per group). No statistical differences were observed in clinicopathological or surgical data between groups, considering both groups well-balanced for analysis. Overall survival at 3 years was 64.3% for SPL vs. 62.3% for EIPL (p 0.421). Only three patients had at least one positive peritoneal cytology (1:2). There were no differences regarding postoperative complications (SPL: 37.2% vs. EIPL: 32.5%, p 0.65) or between location of recurrence and number of recurrences. The number of recurrences did not differ between surgical approaches, but locoregional and peritoneal recurrences were fewer with the laparoscopic approach (p 0.048).

CONCLUSIONS

The regular use of extensive peritoneal lavage in patients with locally advanced gastric cancer, regardless of peritoneal cytology, has not been effective as prophylaxis of peritoneal recurrence or better survival.

[Impact of acid mining drainage on the quality of superficial waters and sediments in the Marrakesh region, Morocco]

The aim of the present study is the evaluation of the effects of the acid drainage of three abandoned mining sites: SB-Othmane, Kettara and Draâ-sfar, on water and sediment quality of the Tensift River and its two temporary tributaries, the Kettara and El-Coudia Oueds. These mining sites located near Marrakesh contain mining residues abandoned for ten to twenty years. They are presently in an agricultural region of the Haouz district. In each site, these uncontrolled mining residues present a high level of metallic sulphide and generate, during rainy periods, leaching products which have physical and chemical characteristics of acid mine drainage (AMD). These percolates display an acidic pH ranging from 2.5 to 5.2, a high electric conductivity, large amounts of sulphate and heavy metals, especially under dissolved form (e.g. Cd: 17.34 mg l(-1); Fe: 1734 mg l(-1); Zn: 3935 mg l(-1)). Except for Pb, the free ionic form is the most abundant metallic form, as showed by calculations using the speciation GEOCHEM program. The analysis of water and sediments of the surrounding superficial aquatic ecosystems shows a modification of water chemical facies and an enrichment in heavy metals, mainly under the solid phase for Fe, Pb, Cu, Co, Cr and Ni, and under dissolved fraction for Cd and Zn. The dissolved fraction of these metals is dominated by the free ionic form, considered as available for organisms. Furthermore, sediments contain important quantities of heavy metals (Pb: 1450 microg g(-1), Zn: 1562 microg g(-1)) with an available fraction which is higher than 40% for the Cd and Zn. The abundance of trace elements (free ionic and available forms) in water and sediment presents a durable risk of their transfer to food chains.

[Study of the effect of earthworm Lumbricus terrestris on the speciation of heavy metals in soils]

Evaluation of the effect of earthworm Lumbricus terrestris on the speciation of copper and cadmium was carried out on two types of soils with a high metallic contamination due to municipal wastes spreading. The concentrations of total dissolved metals were higher in the soil containing earthworms. This increase was larger for the soil submitted to disturbance by earthworms for a long time (3 months). The main chemical species in the lixiviates of all type of soils including controls, were labile forms of cadmium with 52 to 87% and stable forms of copper which represents 67 to 95% of total concentration of dissolved metal. In the solid phase, there was a slight transfer of cadmium and copper from the oxidizable fraction into the exchangeable and acid soluble fractions. This suggests that soil disturbance by earthworms increases the mobility of these metals particularly cadmium. On the contrary copper appears in lixiviates as non labile organic complexes. Analysis of the whole results showed differences between soils as regards the mobility of the metals studied, which reflected the role of the mains physico-chemical characteristics (pH, C.E.C. and total calcareous content).

[Influence of the earthworm Lumbricus terrestris on soil solution complexation capacity]

Four soil samples highly contaminated with metals of urban and mine origin (SE1, SE2, SM1, SM2) and having different physico-chemical proprieties were selected to study copper complexation capacity (LT) of soil solution. The effect of Lumbricus terrestris on copper complexation capacity of soil solution was investigated on SE1 and SE2. The complexation capacity was estimated by amperometric titration of soil solution by copper. Free hydrated cation and labile complexes of copper were determined by DPASV. The results show that the copper complexation capacity variation depends on the physico-chemical characteristics of soils, particularly pH. Thus, the values of copper complexation capacity are 0; 0.6 x 10(-7); 1.8 x 10(-7) and 5.5 x 10(-7) mol l-1 respectively for SM2; SM1; SE1 and SE2 which are pH 5; 5.4; 6.5 and 7.4. Based on these results, the bioavailability levels of heavy metals show the following pool ranking: SM2 > SM1 > SE1 > SE2. The copper complexation capacity of soil solution increases with the soil disturbance by Lumbricus terrestris. This is more obvious when the time of disturbance by lumbrics is longer. Indeed, average values determined for 1 month and 3 months are 3.8 x 10(-7) and 7.8 x 10(-7) mol l-1 for SE1; 7.7 x 10(-7) and 15.2 x 10(-7) mol l-1 for SE2 respectively. It seems that the action of earthworm on soil can contribute to the decrease of bioavailability of heavy metals, particularly copper.