title: Positive Peritoneal Lavage Cytology -Implications for Staging and Management of Gastric Cancer.
abstract: The survival rates of gastric cancer patients with cytology-positive peritoneal lavage fluid without macroscopic dissemination (CY+/P-) is the same as that of patients with overt peritoneal metastasis.The 5-year survival rate of such patients is only 2%. The current study aims to highlight its significance in the staging of gastrointestinal malignancies and its implications for patient care. Prospective nonrandom analysis of peritoneal wash cytology in patients with gastrointestinal malignancies was conducted in the department of Surgical Gastroenterology, Nizams Institute of Medical Sciences, Hyderabad from January 2012 to June 2013. Descriptive statistics and ANOVA variance analysis was performed to estimate incidence, risk factors and the effect of surgery in causing peritoneal dissemination of malignancy. A total of 60 patients with operable gastric cancer underwent peritoneal lavage for evaluation of malignant cells. The incidence of Positive peritoneal lavage cytology was 8.3% (5/60).Four patients with positive lavage fluid belong to T3 stage (11.7%, p-0.309).Poorly differentiating and mucinous tumors had a higher incidence of positive cytology (18.1% and 25%).None of the patients with positive cytology had positive resection margin. Tumors with advanced T stage, lymph nodal involvement, lympho-vascular and perineural invasion have higher incidence of positive peritoneal cytology. Surgical handling has a negligible effect in peritoneal dissemination of tumor. Large scale studies are warranted to validate the findings and define it's role in management of gastric cancer.
authors.affiliation: Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, 500082 India ; Department of Surgery, Bronx-Lebanon Hospital Center, Ichan School of Medicine at Mount Sinai, 1650 Grand Concourse, New York, NY 10457 USA.
authors.forename: Suman B
authors.initials: SB
authors.lastname: Koganti
authors.affiliation: Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, 500082 India.
authors.forename: Satish
authors.initials: S
authors.lastname: Boddepalli
authors.affiliation: Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, 500082 India.
authors.forename: Muralidhar
authors.initials: M
authors.lastname: Nambada
authors.affiliation: Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, 500082 India.
authors.forename: Venu Madhav
authors.initials: VM
authors.lastname: Thumma
authors.affiliation: Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, 500082 India.
authors.forename: Bheerappa
authors.initials: B
authors.lastname: Nagari
authors.affiliation: Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, 500082 India.
authors.forename: R A
authors.initials: RA
authors.lastname: Sastry
keywords: AJCC-American joint committee on cancer; PPC-positive peritoneal wash cytology; TNM-tumor, node, metastasis