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Gastric Cancer

, Volume 10, Issue 1, pp 24–28 | Cite as

Distribution of free cancer cells in the abdominal cavity suggests limitations of bursectomy as an essential component of radical surgery for gastric carcinoma

  • Yoshitaka Yamamura
  • Seiji Ito
  • Yoshinari Mochizuki
  • Hayao Nakanishi
  • Masae Tatematsu
  • Yasuhiro Kodera
Original article

Abstract

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.

Conclusion

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.

Key words

Bursectomy Real-time RT-PCR Cytology Peritoneal metastasis 

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Copyright information

© International and Japanese Gastric Cancer Association 2007

Authors and Affiliations

  • Yoshitaka Yamamura
    • 1
  • Seiji Ito
    • 1
  • Yoshinari Mochizuki
    • 1
  • Hayao Nakanishi
    • 2
  • Masae Tatematsu
    • 2
  • Yasuhiro Kodera
    • 3
  1. 1.Department of Gastroenterological SurgeryAichi Cancer Center HospitalNagoyaJapan
  2. 2.Laboratory of PathologyAichi Cancer Center Research InstituteNagoyaJapan
  3. 3.Second Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan

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