Radical resection is currently the most effective and preferred treatment for HBP cancer, including liver cancer, biliary cancer, and pancreatic cancer. However, postoperative recurrence and metastasis of HBP is still the leading cause of treatment failure. Currently accepted factors related to the recurrence and metastasis of HBP cancer after radical surgery include: the presence of free cancer cells in the abdominal cavity, the surgical procedures leading to shedding and implantation of cancer cells, and the injuries or dysfunction in cancer immune surveillance related to postoperative inflammation. Comprehensive treatment of HBP cancer can improve the long-term clinical efficacy of HBP cancer by improving the long-term survival rate of patients and preventing tumor recurrence and metastasis. At present, intravenous systemic chemotherapy for peripheral blood vessels of patients with HBP cancer is still not efficient. Intraperitoneal chemotherapy for the surgical area after HBP cancer excision might be the right choice. Intraperitoneal chemotherapy has the following advantages: 1) Intraperitoneal chemotherapy has less stimulation to the peritoneal, gastrointestinal, and other normal abdominal contents. When chemotherapy drugs are immersed in the abdominal cavity, the drugs can effectively reach all areas of the abdominal cavity and directly target the cancer cells in the abdominal cavity, which improves the killing ability of chemotherapy drugs to the tumor cells in the abdominal cavity. 2) The low intraperitoneal penetration rate of intraperitoneal chemotherapy can ensure high drug concentration. 3) Intraperitoneal chemotherapy has a steady infiltration of tumor tissue, and the main reason for recurrence after hepatobiliary pancreatic cancer resection is that cancer cells invade veins to form venous cancer thrombus and microtumor thrombus, and tumor metastasis along the vein is the main route of metastasis[17, 18]. However, after the chemotherapy drugs are absorbed in the abdominal cavity, they can infuse into the liver through the portal vein and inhibit the growth of the residual tumor cells in the liver, bile, and pancreas. 4) Chemotherapy drugs can directly act on lymph nodes with tumor cell metastasis through lymphatic absorption. Only a small portion of the drug infuses through the body. Thus there are fewer adverse reactions. Therefore, intraperitoneal chemotherapy is currently considered as a highly specific regional chemotherapy, with less systemic adverse reactions. It has been recommended to perform postoperative early intraperitoneal chemotherapy to prevent implantation of cancer cells. Our data provided evidence that intraoperative intraperitoneal chemotherapy was a safe approach with fewer side effects in patients with HBP cancer. Moreover, intraoperative intraperitoneal chemotherapy indeed decreased the recurrence or metastasis of HBP cancer after surgery.
Lobaplatin is currently the third generation of platinum drugs. It blocks the deoxyribonucleic acid (DNA) replication and transcription process by GG and AG intra-strand cross-links, thus interfering with the operation of the tumor cell cycle. Its advantages include a broader anti-tumor spectrum, more potent anti-tumor activity, higher water solubility, less cross-resistance, and fewer side effects compare with other platinum-based drugs. Therefore, it is suitable for intra-abdominal chemotherapy. Since chemotherapy drugs enter slowly through the “peritoneal-plasma” barrier, lobaplatin enters the body circulation within five postoperative hours, thus causing relatively less influence on the blood system and systemic toxic side reactions. When used in the veins, the most significant adverse reaction of lobaplatin is the decrease in platelet levels. Our study demonstrated that lobaplatin had a relatively lighter inhibitory impact on PLT and WBC; also, it had no effects on the postoperative liver and kidney functions. Moreover, we found that intraoperative intraperitoneal chemotherapy with lobaplatin reduced the incidence of intraperitoneal implantation and metastasis of hepatocellular carcinoma, suggesting that intraoperative intraperitoneal chemotherapy using lobaplatin have a certain therapeutic significance for reducing postoperative recurrence of HBP tumor. Due to the small number of cases included in the study, further accumulation of cases is needed to obtain more data to investigate the efficacy of intraoperative intraperitoneal chemotherapy with lobaplatin for HBP cancer.