title: Does the intraoperative peritoneal lavage cytology add prognostic information in patients with potentially curative gastric resection?
abstract: Peritoneal recurrence is the foremost pattern of failure after potentially curative resection for gastric cancer. Our aim was to evaluate the prognostic value of intraperitoneal free cancer cells (IFCCs) in peritoneal lavage of patients who underwent potentially curative resection for gastric carcinoma. Two hundred twenty patients with gastric cancer stage I, II, or III were prospectively evaluated with peritoneal lavage and cytologic examination. Aspirated fluid from the abdominal cavity was centrifuged and subjected to Papanicolaou staining. The mean age was 60.9 years (range, 21-89 years), and 63.6% were men. IFCCs were detected in 6.8% of the patients; suspicious in 2.7%, and negative in 84.5%. No judgment could be given in 5.9% of the cases. Invasion of the gastric serosa (pT3) was observed in all positive cytology patients. Patients with IFCCs had a mean survival time of 10.5 months, while those with negative IFCC had a mean survival time of 61 months (P = 0.00001). There was no correlation between the presence of IFCCs and tumor size, histology, pN, or tumor site. Our conclusions are that (1) positive cytology indicates a poor prognosis in patients who underwent potentially curative gastric resection and (2) peritoneal lavage cytology improves staging in assessing these patients and may alter their therapeutic approach.
authors.affiliation: Department of Gastroenterology, University of São Paulo, Rua Treze de Maio 1954, Cj. 54, São Paulo-SP 01327-002, Brazil. ulyssesribeiro@terra.com.br
authors.forename: Ulysses
authors.initials: U
authors.lastname: Ribeiro
authors.forename: Adriana V
authors.initials: AV
authors.lastname: Safatle-Ribeiro
authors.forename: Bruno
authors.initials: B
authors.lastname: Zilberstein
authors.forename: Donato
authors.initials: D
authors.lastname: Mucerino
authors.forename: Osmar Kenji
authors.initials: OK
authors.lastname: Yagi
authors.forename: Cláudio Caldas
authors.initials: CC
authors.lastname: Bresciani
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Jacob
authors.forename: Kyioshi
authors.initials: K
authors.lastname: Iryia
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gama-Rodrigues
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007430:Intraoperative Care; D007813:Laparotomy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010529:Peritoneal Cavity / Q000473:pathology*; D010533:Peritoneal Lavage; D011379:Prognosis; D011446:Prospective Studies; D012704:Serous Membrane / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome