Distribution of free cancer cells in the abdominal cavity suggests limitations of bursectomy as an essential component of radical surgery for gastric carcinoma.
BACKGROUND
Bursectomy, which has been performed so as to resect peritoneal deposits disseminated within the omental bursa, is considered as an essential component of radical surgery for gastric carcinoma in Japan. Bursectomy has also been described in the Japanese Treatment Guidelines for Gastric Carcinoma as a mandatory procedure for the treatment of serosa-positive cancer. However, no evidence to support the prognostic significance of this procedure has been reported to date.


METHODS
Cytologic examination and real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis of the peritoneal washes obtained from the Douglas pouch, left subphrenic cavity, and inside the omental bursa were performed for 136 patients who underwent potentially curative surgery for gastric carcinoma.


RESULTS
Carcinoembryonic antigen (CEA) or cytokeratin (CK) 20 mRNA was detected in one or more samples from the three different sites of peritoneal washes in 43 of the 136 patients. In 14 patients, the mRNAs were detected in samples obtained from the bursa omentalis (10.3% of all patients and 32.6% of patients with positive RT-PCR results). In 12 of these 14 patients, the mRNAs were also detected in samples taken from either or both of the remaining two sites. Only in the 2 other patients was the sample only from inside the omental bursa positive for CEA.


CONCLUSIONS
It is unlikely that viable cancer cells disseminated into the bursa remain restricted to this cavity without migrating into the free abdominal cavity. Routine bursectomy may not be an essential procedure for resecting gastric cancer, from the viewpoint of eliminating microscopic peritoneal deposits within the omental bursa.
Yamamura
Yoshitaka
Y
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.
Ito
Seiji
S
Mochizuki
Yoshinari
Y
Nakanishi
Hayao
H
Tatematsu
Masae
M
Kodera
Yasuhiro
Y
D034841:Abdominal Cavity; D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D002272:Carcinoembryonic Antigen / Q000032:analysis; D005987:Glyceraldehyde-3-Phosphate Dehydrogenases / Q000032:analysis; D006801:Humans; D053554:Keratin-20 / Q000032:analysis; D009366:Neoplasm Seeding; D009852:Omentum / Q000601:surgery; D010533:Peritoneal Lavage; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery*; D010537:Peritoneum / Q000166:cytology* / Q000601:surgery; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
D002272:Carcinoembryonic Antigen; D053554:Keratin-20; D005987:Glyceraldehyde-3-Phosphate Dehydrogenases