Urachal adenocarcinoma (UrAC) is a rare malignancy that can cause peritoneal metastases (PM). Analogous to other enteric malignancies, selected patients with limited PM of UrAC can be treated by cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).
The aim of this study was to address the value of diagnostic laparoscopy (DLS) and abdominal cytology (ACyt) for the detection and evaluation of the extent of PM in patients with UrAC.
A consecutive series of cN0M0 patients with UrAC who underwent DLS with or without ACyt at a tertiary referral center between 2000 and 2018 was assessed. Patients were staged with computed tomography (CT) and/or positron emission tomography (PET)/CT or bone scan. DLS was performed to rule out PM and to evaluate the extent and resectability of PM if seen on imaging. Sensitivity and specificity values were calculated for imaging, DLS, ACyt, and the combination of DLS and ACyt.
Thirty-two patients with UrAC underwent DLS. ACyt was obtained in 19 patients. Four patients had suspicion of PM on imaging. In the 28 patients who were PM-negative on imaging, DLS and ACyt revealed PM in 6 (21%) patients, of whom 5 had macroscopically visible PM; 1 patient had positive ACyt without visible PM. Sensitivity of combined DLS/ACyt for the detection of PM was 91%, with a specificity of 100%, whereas sensitivity of imaging was 36%. DLS correctly predicted resectability in all patients.
Combined DLS/ACyt proved an effective tool to detect occult PM and to evaluate the extent of PM to select UrAC patients for possible treatment with CRS/HIPEC.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Collins DC, Velazquez-Kennedy K, Deady S, Brady AP, Sweeney P, Power DG. National incidence, management and survival of urachal carcinoma. Rare Tumors. 2016;8(3):97–101. https://doi.org/10.4081/rt.2016.6257.
Zong L, Chen P. Surgical and chemotherapeutic experience regarding a urachal carcinoma with repeated relapse: case report and literature review. World J Surg Oncol. 2013;11(170):1–8. https://doi.org/10.1186/1477-7819-11-170.
Szarvas T, Mdos O, Niedworok C, et al. Clinical, prognostic, and therapeutic aspects of urachal carcinoma. A comprehensive review with meta-analysis of 1,010 cases. Urol Oncol Semin Orig Investig. 2016;34(9):388–98. https://doi.org/10.1016/j.urolonc.2016.04.012.
Iversen LH, Rasmussen PC, Laurberg S. Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. Br J Surg. 2013;100(2):285–92. https://doi.org/10.1002/bjs.8908.
Witkamp AJ, De Bree E, Kaag MM, et al. Extensive cytoreductive surgery followed by intra-operative hyperthermic intraperitoneal chemotherapy with mitomycin-C in patients with peritoneal carcinomatosis of colorectal origin. Eur J Cancer. 2001;37(8):979–84. https://doi.org/10.1016/s0959-8049(01)00058-2.
Witkamp AJ, De Bree E, Kaag MM, Van Slooten GW, Van Coevorden F, Zoetmulder FAN. Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. Br J Surg. 2001;88(3):458–63. https://doi.org/10.1046/j.1365-2168.2001.01701.x.
Yan TD, Deraco M, Baratti D, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: multi-institutional experience. J Clin Oncol. 2009;27(36):6237–42. https://doi.org/10.1200/jco.2009.23.9640.
Piso P, Bektas H, Werner U, et al. Improved prognosis following peritonectomy procedures and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from appendiceal carcinoma. Eur J Surg Oncol. 2001;27(3):286–90. https://doi.org/10.1053/ejso.2000.1095.
van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer. N Engl J Med. 2018;378(3):230–40. https://doi.org/10.1056/nejmoa1708618.
Mertens LS, Behrendt MA, Mehta AM, et al. Long-term survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal metastases of urachal cancer. Eur J Surg Oncol. 2019;45(9):1740–4. https://doi.org/10.1016/j.ejso.2019.03.034.
Mercier F, Passot G, Villeneuve L, et al. Peritoneal carcinomatosis of urachus origin treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC): an international registry of 36 patients. Ann Surg Oncol. 2018;25(4):1094–100. https://doi.org/10.1245/s10434-017-6299-z.
Laghi A, Bellini D, Rengo M, et al. Diagnostic performance of computed tomography and magnetic resonance imaging for detecting peritoneal metastases: systematic review and meta-analysis. Radiol Med. 2017;122(1):1–15. https://doi.org/10.1007/s11547-016-0682-x.
Koh J-L, Yan TD, Glenn D, Morris DL. Evaluation of preoperative computed tomography in estimating peritoneal cancer index in colorectal peritoneal carcinomatosis. Ann Surg Oncol. 2009;16(2):327–33. https://doi.org/10.1245/s10434-008-0234-2.
Burbidge S, Mahady K, Naik K. The role of CT and staging laparoscopy in the staging of gastric cancer. Clin Radiol. 2013;68(3):251–5. https://doi.org/10.1016/j.crad.2012.07.015.
Nakagawa S, Nashimoto A, Yabusaki H. Role of staging laparoscopy with peritoneal lavage cytology in the treatment of locally advanced gastric cancer. Gastric Cancer. 2007;10(1):29–34. https://doi.org/10.1007/s10120-006-0406-3.
Joseph S, Connor S, Garden OJ. Staging laparoscopy for cholangiocarcinoma. HPB. 2008;10(2):116–9. https://doi.org/10.1080/13651820801992690.
Bird N, Elmasry M, Jones R, et al. Role of staging laparoscopy in the stratification of patients with perihilar cholangiocarcinoma. Br J Surg. 2017;104(4):418–25. https://doi.org/10.1002/bjs.10399.
Barlow AD, Garcea G, Berry DP, et al. Staging laparoscopy for hilar cholangiocarcinoma in 100 patients. Langenbeck’s Arch Surg. 2013;398(7):983–8. https://doi.org/10.1007/s00423-013-1104-3.
Ikoma N, Blum M, Chiang YJ, et al. Yield of staging laparoscopy and lavage cytology for radiologically occult peritoneal carcinomatosis of gastric cancer. Ann Surg Oncol. 2016;23(13):4332–7. https://doi.org/10.1245/s10434-016-5409-7.
Jimenez RE, Warshaw AL, Rattner DW, Willett CG, McGrath D, Fernandez-del Castillo C. Impact of laparoscopic staging in the treatment of pancreatic cancer. Arch Surg. 2000;135(4):405–9.
National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology. https://www.nccn.org/professionals/physician_gls/pdf/aml.pdf.
Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res. 1996;82:359–74. https://doi.org/10.1007/978-1-4613-1247-5.
Verwaal VJ, Van Tinteren H, Van Ruth S, Zoetmulder FAN. Predicting the survival of patients with peritoneal carcinomatosis of colorectal origin treated by aggressive cytoreduction and hyperthermic intraperitoneal chemotherapy. Br J Surg. 2004;91(6):739–46. https://doi.org/10.1002/bjs.4516.
Mezhir JJ, Posner MC, Roggin KK. Prospective clinical trial of diagnostic peritoneal lavage to detect positive peritoneal cytology in patients with gastric cancer. J Surg Oncol. 2013;107(8):794–8. https://doi.org/10.1002/jso.23328.
Patel CM, Sahdev A, Reznek RH. CT, MRI and PET imaging in peritoneal malignancy. Cancer Imaging. 2011;11:123–39. https://doi.org/10.1102/1470-7330.2011.0016.
No sources of funding were used to assist in the preparation of this study.
Laura E. Stokkel, Akash M. Mehta, Mark A. Behrendt, Jeroen de Jong, Elise M. Bekers, Kees Hendricksen, Arend G.J. Aalbers, Niels F.M. Kok, Wim Meinhardt, Laura S. Mertens, and Bas W.G van Rhijn have no conflicts of interest to declare.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Stokkel, L.E., Mehta, A.M., Behrendt, M.A. et al. Diagnostic Laparoscopy and Abdominal Cytology Reliably Detect Peritoneal Metastases in Patients with Urachal Adenocarcinoma. Ann Surg Oncol (2020). https://doi.org/10.1245/s10434-020-08206-1