Is peritoneal cytology a predictor of unresectability in pancreatic carcinoma?
OBJECTIVE
Demonstration of unresectability often requires diagnostic laparotomy with high co-morbidity in pancreatic carcinoma. The value of detected peritoneal tumor cells and influence on outcome should be determined.


METHODS
In a prospective study 150 consecutive patients with pancreatic carcinoma were evaluated. Improvement of diagnostic accuracy in diagnosing unresectability was calculated for combination of CT, endoscopic ultrasonography and peritoneal cytology.


RESULTS
Unexpected subglissonian metastases were found in 10%. 87 patients with peritoneal washings were included in the study, 20 patients with detected peritoneal tumor cells (n=22) were inoperable. In all patients of this group the ventral integrity of pancreas was damaged. In 23 patients with preoperative existent ascites, only in 4 cases could peritoneal tumor cells be detected. In patients with positive cytology together with disrupted ventral pancreatic margin as predictors of unresectability, sensitivity was 100% and specificity 96%.


CONCLUSIONS
Addition of diagnostic laparoscopy combined with peritoneal cytology and minimally invasive palliation procedures (endoscopic biliary prosthesis, laparoscopic gastrojejunostomy) to the staging-protocol for pancreatic carcinoma may decrease operative lethality and unnecessary laparotomies may be avoided safely. As unexpected subglissonian micrometastases may additionally be present in 5-10%, perioperative laparoscopy is always advisable.
Schmidt
Johannes
J
Department of Surgery, University Witten-Herdecke, Wuppertal, Germany. hschmidt@klinikum-wuppertal.de
Fraunhofer
Stefan
S
Fleisch
Markus
M
Zirngibl
Hubert
H
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D001202:Ascitic Fluid / Q000166:cytology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome