Does the intraoperative peritoneal lavage cytology add prognostic information in patients with potentially curative gastric resection?
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.
Ribeiro
Ulysses
U
Department of Gastroenterology, University of São Paulo, Rua Treze de Maio 1954, Cj. 54, São Paulo-SP 01327-002, Brazil. ulyssesribeiro@terra.com.br
Safatle-Ribeiro
Adriana V
AV
Zilberstein
Bruno
B
Mucerino
Donato
D
Yagi
Osmar Kenji
OK
Bresciani
Cláudio Caldas
CC
Jacob
Carlos Eduardo
CE
Iryia
Kyioshi
K
Gama-Rodrigues
Joaquim
J
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