Abstract
Presence of free gastric cancer cells in the peritoneal cavity of patients who undergo surgical treatment for gastric cancer is considered as a negative prognostic factor. It manifests as peritoneal metastasis and causes rapid recurrence of diseases. The aim of this study was to analyse factors associated with positive peritoneal cytology and identify patients in whom diagnostic peritoneal lavage could affect therapeutic decisions. The study enrolled patients with gastric cancer who underwent surgical treatment at the Department of General and Minimal Invasive Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, over a period of 18 months from November of 2017 to May of 2019. During the laparotomy, 200 mL of physiological saline at 37 °C was administered in the tumour region. About 100 mL fluid was recovered from several regions of the abdominal cavity which was sent to the Department of Pathology where the samples were processed by liquid-based cytology technique. Results of peritoneal cytology were analysed jointly on the basis of clinical and pathological factors. Analysis of the peritoneal fluid for presence of free cancer cells was done in 52 patients. Positive peritoneal cytology was found in 9 (17.3%) patients. In the group of patients with positive cytology, all patients had T4 tumours and all were found to have lymph node metastases, whilst as grade 3 cancer was found in 55.5% patients. In patients with positive cytology, diffuse gastric cancer was seen in 7 out of 9 patients (77.7%), whilst in patients with negative cytology, intestinal type was seen in 41 of 43 patients (95.3%). Amongst the 9 patients with positive peritoneal cytology, 7 (77.7%) patients had tumour located in the distal part, and one (11.1%) patient had tumour located in the proximal part, whilst the lone patient with diffuse involvement of the stomach was also positive for malignant peritoneal cells. Based on this study, we can conclude that determinants of positive peritoneal cytology include tumour stage (T4), positive nodal status (N +). Knowing the peritoneal cytology status can alter the treatment strategy and can vary from curative to a palliative one and vice versa.
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References
Ferro A, Peleteiro B, Malvezzi M, Bosetti C, Bertuccio P, Levi F et al (2014) Worldwide trends in gastric cancer mortality (1980–2011), with predictions to 2015, and incidence by subtype. Eur J Cancer 50:1330–1344
Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T et al (2011) Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 29:4387–4393
Pavithran K, Doval DC, Pandey KK (2002) Gastric cancer in India. Gastric Cancer 5:240–243
Henson DE, Dittus C, Younes M, Nguyen H, Albores-Saavedra J (2004) Differential trends in the intestinal and diffuse types of gastric carcinoma in the United States, 1973–2000: increase in the signet ring cell type. Arch Pathol Lab Med 128:765–770
Avital I, Pisters PWT, Kelsen DP, Willett CG (2011) Cancer of the stomach. DeVita VT, Lawrence TS, Rosenberg SA. DeVita, Hellman, and Rosenberg’s cancer: principles and practice of oncology. 9th ed. Philadelphia: Lippincott Williams & Wilkins, pp 924–54
National Comprehensive Cancer Network.(2016) NCCN Clinical practice guidelines in oncology: gastric cancer. Version 3
Waddell T, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol Suppl 6:vi57–63
Stomach. Edge SB, Byrd DR, Compton CC, et al (2002) AJCC Cancer staging manual. 7th ed. New York: Springer,p 120
Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L (1999) Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Italian Gastrointestinal Tumor Study Group. Ann Surg 230(2):170–8
Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, et al. van de Velde, CJ (1999) Extended lymph node dissection for gastric cancer. N Engl J Med 340:908
Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I et al (2004) Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 22(11):2069–2077
Nakajima T, Nishi M, Kajitani T (1991) Improvement in treatment results of gastric cancer with surgery and chemotherapy: experience of 9700 cases in the Cancer Institute Hospital. Tokyo Semin Surg Oncol 7:365–372
Fuchs CS, Mayer RJ (1995) Gastric carcinoma. N Engl J Med 333:32–41
Maekawa S, Saku M, Maehara Y et al (1996) Surgical treatment for advanced gastric cancer. Hepatogastroenterology 43:178–186
Iitsuka Y, Shiota S, Matsui T et al (1990) Relationship between the cytological characteristics of intraperitoneal free cancer cells and the prognosis in patients with gastric cancer. Acta Cytol 34:437–442
Ikeguchi M, Oka A, Tsujitani S et al (1994) Relationship between area of serosal invasion and intraperitoneal free cancer cells in patients with gastric cancer. Anticancer Res 14:2131–2134
Bentrem D, Wilton A, Mazumdar M et al (2005) The value of peritoneal cytology as a preoperative predictor in patients with gastric carcinoma undergoing a curative resection. Ann Surg Oncol 12(5):1–7
Kodera Y, Yamamura Y, Shimizu Y, et al (1999) Peritoneal washing cytology: prognostic value of positive findings in patients with gastric carcinoma undergoing a potentially curative resection. J Surg Oncol 72(2):60–4 (discussion 4–5).
Nath J, Moorthy K, Taniere P, Hallissey M, Alderson D (2008) Peritoneal lavage cytology in patients with oesophagogastric adenocarcinoma. Br J Surg 95:721–726
Hayes N, Wayman J, Wadehra V et al (1999) Peritoneal cytology in the surgical evaluation of gastric carcinoma. Br J Cancer 79:520–524
Abe S, Yoshimura H, Tabara H et al (1995) Curative resection of gastric cancer: limitation of peritoneal lavage cytology in predicting the outcome. J Surg Oncol 59(4):226–229
Iitsuka Y, Kaneshima S, Tanida O et al (1979) Intraperitoneal free cancer cells and their viability in gastric cancer. Cancer 44:1476–1480
La Torre M, Ferri M, Giovagnoli MR et al (2010) Peritoneal wash cytology in gastric carcinoma. Prognostic significance and therapeutic consequences. Eur J Surg Oncol 36:982e986
Hiratsuka M, Furukawa H, Iwanaga T, et al (1998) Peritoneal lavagecytology and intraperitoneal chemotherapy. In: Yonemura, ed. Peritoneal dissemination. Molecular mechanisms and the latest therapy. Kanazawa, Japan: Maeda Shoten, pp 201–214.
Bonenkamp JJ, Songun I, Hermans J, van de Velde CJ (1996) Prognostic value of positive cytology findings from abdominal washings in patients with gastric cancer. br J Surg 83:672–74
Koga S, Kaibara N, Iitsuka Y et al (1984) Prognostic significance of intraperitoneal free cancer cells in gastric cancer patients. Cancer Res Clin Oncol 108:236–238
Radosław Lisiecki, Arkadiusz Spychała, Katarzyna Pater, Dawid Murawa (2015) Analysis of risk factors of positive peritoneal cytology in patients treated for gastric cancer Polski Przegląd Chirurgiczny 87(10): 506–512
Mezhir JJ, Shah MA, Jacks LM, Brennan MF, Coit DG, Strong VE (2010) Positive peritoneal cytology in patients with gastric cancer: natural history and outcome of 291 patients. Ann Surg Oncol 17(12):3173–3180
Nakajima T, Harashima S, Hirata M, Kajitani T (1978) Prognostic and therapeutic values of peritoneal cytology in gastric cancer. Acta Cytol 22:225–229
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Mir, T.A., Malik, A.A., Wani, M.A. et al. Gastric Carcinoma—a New Biomarker Peritoneal Fluid Lavage Cytology. Indian J Surg 85, 76–82 (2023). https://doi.org/10.1007/s12262-022-03386-4
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DOI: https://doi.org/10.1007/s12262-022-03386-4