Laparoscopic peritoneal lavage in staging gastric and oesophageal cancer.
OBJECTIVE
Accurate staging of gastric, oesophageal and oesophagogastric cancer is essential to avoid unnecessary laparotomies in patients where only palliation is appropriate. This requires a multimodal approach utilizing endoscopy, computed tomography and laparoscopy. Previous authors have found that the presence of free peritoneal tumour cells (FPTCs) detected at laparoscopy or laparotomy confers a poorer prognosis. However, various methods of peritoneal lavage are described. The aim of this study was to evaluate the prognostic value of our technique of peritoneal lavage.


METHODS
88 staging laparoscopies with peritoneal lavage were carried out between March 1997 and February 1999 on patients eligible for attempted curative resection of a gastric, oesophageal or oesophagogastric cancer. During laparoscopy the pelvis was irrigated with 200 ml of normal saline, with 100 ml aspirated and examined cytologically. Patients were followed-up until September, 1999.


RESULTS
11 patients had FPTC-positive cytology with a median survival following laparoscopy of 122 days (95% CI 82-161) with only a single patient surviving more than one year. In the FPTC-negative group, median survival was 378 days (95% CI 256,-). Log-rank Chi(2)=16.7, P<0.001.


CONCLUSIONS
The presence of FPTCs detected by our technique is a contraindication to attempted curative resection - palliation only (medical or surgical) is appropriate.
Bryan
R T
RT
The Institute for Cancer Studies, The University of Birmingham, Birmingham, UK.
Cruickshank
N R
NR
Needham
S J
SJ
Moffitt
D D
DD
Young
J A
JA
Hallissey
M T
MT
Fielding
J W
JW
D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010533:Peritoneal Lavage / Q000379:methods*; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology*; D016019:Survival Analysis