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Prognostic Significance of Intraoperative Peritoneal Lavage Cytology in Patients with Pancreatic Ductal Adenocarcinoma: A Single-Center Experience and Systematic Review of the Literature

  • Pancreatic Tumors
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Abstract

Background

The prognostic significance of peritoneal lavage cytology (PLC) in patients with pancreatic ductal adenocarcinoma (PDAC) remains controversial. The purpose of this study was to evaluate the prognostic impact of PLC status in PDAC patients.

Methods

Patients intending to undergo resection for PDAC between 2007 and 2020 were included. Survival was compared among patients who underwent resection with negative or positive PLC status and those who did not undergo resection. Univariable and multivariable analyses were conducted to evaluate the prognostic impact of positive PLC status. A systematic literature review was performed to evaluate the correlation between prognosis and the positive PLC rate.

Results

A total of 480 patients formed the study cohort and were divided as follows: 438 in the negative PLC group, 18 in the positive PLC group, and 24 in the no resection group. Although the median survival time significantly differed between the negative and positive PLC groups (35.7 vs. 13.6 months, P < 0.001), it did not significantly differ between the positive PLC and no resection groups (13.6 vs. 12.2 months, P = 0.605). Multivariable analyses demonstrated that positive PLC status (hazard ratio = 3.54, 95% confidence interval = 1.97–6.38, P < 0.001) was the strongest poor prognostic factor. Based on statistical analyses for the systematic review, the prognostic impact of positive PLC status weakened significantly as the institutional positive PLC rate increased (P = 0.044).

Conclusions

Resection did not improve the prognosis of patients with positive PLC status in our cohort. The institutional positive PLC rate may be a good reference for surgical indication in these patients.

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Funding

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, 464-8681, Japan

    Shoji Kawakatsu MD, Yasuhiro Shimizu MD, Seiji Natsume MD, Masataka Okuno MD, Seiji Ito MD, Koji Komori MD, Tetsuya Abe MD, Kazunari Misawa MD, Yuichi Ito MD, Takashi Kinoshita MD, Eiji Higaki MD, Hironori Fujieda MD, Yusuke Sato MD, Akira Ouchi MD & Masato Nagino MD

  2. Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan

    Kazuo Hara MD

  3. Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan

    Keitaro Matsuo MD

  4. Division of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Keitaro Matsuo MD

  5. Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan

    Waki Hosoda MD

Authors
  1. Shoji Kawakatsu MD
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  2. Yasuhiro Shimizu MD
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  3. Seiji Natsume MD
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Contributions

Study conception and design: SK, YS, KM. Acquisition of data: SK, HF, YS, AO. Analysis and interpretation of data: SK, KM, SN, MO. Drafting of manuscript: SK, YS, KM, WH. Critical revision: MN, KH, SI, KK, TA, KM, YI, TK, EH. All authors gave final approval of the version to be submitted.

Corresponding author

Correspondence to Yasuhiro Shimizu MD.

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Supplemental Fig. 1

Subgroup analysis for overall survival by postoperative chemotherapy between the positive PLC and no resection groups. a FOLFIRINOX or GNP therapy. b Other chemotherapy regimens. FOLFIRINOX 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan; GNP gemcitabine and nab-paclitaxel (TIF 4014 kb)

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Kawakatsu, S., Shimizu, Y., Natsume, S. et al. Prognostic Significance of Intraoperative Peritoneal Lavage Cytology in Patients with Pancreatic Ductal Adenocarcinoma: A Single-Center Experience and Systematic Review of the Literature. Ann Surg Oncol 29, 5972–5983 (2022). https://doi.org/10.1245/s10434-022-11722-x

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  • DOI: https://doi.org/10.1245/s10434-022-11722-x

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