In Reply This letter is in response to the letters by Batista, Tai et al, and Kanemoto et al. We thank the editors for giving us the opportunity to rebut the issues raised about our study.¹

We are grateful for Batista’s remarks because they reflect a common misinterpretation of postoperative complications. For the Japanese CCOG 1102 randomized clinical trial,² the primary end point is disease-free survival, and secondary end points are overall survival, peritoneal recurrence-free survival, and incidence of adverse events. Thus, detailed records and observations may be lacking in “postoperative complications” such as abdominal pain. Moreover, in the trial including 27 patients by Ronellenfitsch et al,³ only half (14 cases) were pT3/4. Because peritoneal metastasis is caused by direct cancer cell dissemination from serosa-invasive tumors, the low number of patients with free peritoneal tumor cells was detected and the trial was closed early. As the author himself describes, “our study population is too small and long-term follow-up data are presently unavailable, so no sound conclusions can be drawn to that regard.”³ The study of Batista is similar, where only 8 patients were allocated to extensive intraoperative peritoneal lavage (EIPL) protocol. In our study, all surgeons have enough experience for D2 gastrectomy (>100 procedures per year) to ensure the quality of surgery. Therefore, few patients had postoperative complications, including gastrointestinal leakage. Indeed, in the CCOG 1102 study, only 2% cases had gastrointestinal leakages in non-EIPL and EIPL group, respectively.

回信这封信是对Batista，Tai等人和Kanemoto等人的信的答复。我们感谢编辑给我们提供了机会来反驳有关我们的研究提出的问题。^1个

我们感谢巴蒂斯塔的言论，因为它们反映了术后并发症的常见误解。对于日本CCOG 1102随机临床试验，²主要终点为无病生存期，次要终点为总体生存期，腹膜无复发生存期和不良事件发生率。因此，在诸如腹痛之类的“术后并发症”中可能缺少详细的记录和观察结果。此外，在包括Ronellenfitsch等人的27位患者的试验中，³pT3 / 4只有一半（14例）。由于腹膜转移是由浆膜浸润性肿瘤中直接的癌细胞扩散引起的，因此检测到腹膜游离肿瘤细胞的患者人数很少，该试验已提前结束。正如作者本人所描述的那样，“我们的研究人群太小，目前尚无法提供长期的随访数据，因此在这方面无法得出正确的结论。” ³Batista的研究相似，只有8例患者接受了广泛的术中腹腔灌洗（EIPL）方案。在我们的研究中，所有外科医生都具有足够的D2胃切除术经验（每年> 100例手术），以确保手术质量。因此，很少有患者发生包括胃肠道渗漏在内的术后并发症。确实，在CCOG 1102研究中，非EIPL组和EIPL组分别只有2％的患者出现胃肠道渗漏。