Abstract
For gastric cancer patients who have no peritoneal seeding at a macroscopic level but positive results in the peritoneal lavage cytology (PLC), the prognostic benefit expected by surgical resection is still controversial. During the period 1975–1994 as series of 417 consecutive patients without distant organ metastases underwent surgical resection for gastric cancer that had invaded the subserosal or deeper layers of the stomach wall. Immediately after laparotomy, the pouch of Douglas was washed with 100 ml of physiologic saline solution, and the fluid was collected for cytologic examination (four slide glasses) using Giemsa and Papanicolaou staining methods. According to the macroscopic (P) and cytologic (Cyt) results, the 417 patients were classified into three groups: P+ (n = 97); P−/Cyt+ (n = 25); and P−/Cyt− (n = 295). Their 3-year survival rates after surgical resection were 4%, 24%, and 48%, respectively (p = 0.0001: P−/Cyt+ vs. P−/Cyt−; p = 0.0018: P−/Cyt+ vs. P+. Among the 25 P−/Cyt+ patients, postoperative survival was not associated with the T stage, N stage, cellular atypism, or cluster formation but with the number of cancer cells per slide during PLC. The 3-year survival rate was 35% for the subgroup with fewer than 10 cancer cells per slide (17 patients) and 0% for the other subgroup with 10 or more cancer cells per slide (8 patients) (p = 0.017). For P−/Cyt+ patients, who represent a subgroup of gastric cancer patients with an intermediate survival rate between the P−/Cyt− and P+ patients, the number of cancer cells observed during PLC offers a potent prognostic indicator for the gastrectomy.
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References
Burke EC, Karpeh MS Jr, Conlon KC, et al. Peritoneal lavage cytology in gastric cancer: an independent predictor of outcome. Ann. Surg. Oncol. 1998;5:411–415
Gunderson LL, Sosin H. Adenocarcinoma of the stomach: areas of failure in a re-operation series (second or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int. J. Radiat. Oncol. Biol. Phys. 1982;8:1–11
Hiratsuka M, Iwanaga T, Furukawa H, et al. Important prognostic factors in surgically treated gastric cancer patients. Gan To Kagaku Ryoho 1995;22:703–708
Landry J, Tepper JE, Wood WC, et al. Patterns of failure following curative resection of gastric carcinoma. Int. J. Radiat. Oncol. Biol. Phys. 1990;19:1357–1362
Bando E, Yonemura Y, Takeshita Y, et al. Intraoperative lavage for cytological examination in 1,297 patients with gastric carcinoma. Am. J. Surg. 1999;178:256–262
Hayes N, Wayman J, Wadehra V, et al. Peritoneal cytology in the surgical evaluation of gastric carcinoma. Br. J. Cancer 1999;79:520–524
Iitsuka Y, Shiota S, Matsui T, et al. Relationship between the cytologic characteristics of intraperitoneal free cancer cells and the prognosis in patients with gastric cancer. Acta Cytol 1990;34:437–442
Kodera Y, Yamamura Y, Shimizu Y, et al. Peritoneal washing cytology: prognostic value of positive findings in patients with gastric carcinoma undergoing a potentially curative resection. J. Surg. Oncol. 1999;72:60–65
Nakajima T, Harashima S, Hirata M, et al. Prognostic and therapeutic values of peritoneal cytology in gastric cancer. Acta Cytol. 1978;22:225–229
Tanida O, Kaneshima S, Iitsuka Y, et al. Viability of intraperitoneal free cancer cells in patients with gastric cancer. Acta Cytol. 1982;26:681–687
Boku T, Nakane Y, Minoura T, et al. Prognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer. Br. J. Surg. 1990;77:436–439
Bonenkamp JJ, Songun I, Hermans J, et al. Prognostic value of positive cytology findings from abdominal washings in patients with gastric cancer. Br. J. Surg. 1996;83:672–674
Majima T, Ichikura T, Mochizuki H. Prognostic significance of the cytologic features of free cancer cells in the peritoneal cavity of patients with gastric cancer. Surg. Today 2002;32:35–39
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma, 2nd English edition. Gastric Cancer 1998;1:10–24
Hattori S, Tamura H, Matsuda M, et al. Atlas of Cytology, Tokyo, Ishiyaku-shuppan, 1970
Hiratsuka M, Furukawa H, Imaoka S, et al. [Cytology in surgery for gastric cancer.] In Nobuta S, Murohisa T, Koga S, et al. editors, [Cytology in Gastroenterology.], Tokyo, Igakutosho, 1990;185–193
Papanicolaou GN. Atlas of Exfoliative Cytology, Cambridge, MA, The Commonwealth Fund, Harvard University Press, 1963
De la Fuente MT, Casanova B, Garcia-Gila M, et al. Fibronectin interaction with alpha 4 beta 1 integrin prevents apoptosis in B cell chronic lymphocytic leukemia: correlation with Bcl-2 and Bax. Leukemia 1999;13:266–274
Markman M, Brady MF, Spirtos NM, et al. Phase II trial of intraperitoneal paclitaxel in carcinoma of the ovary, tube, and peritoneum: a Gynecologic Oncology Group Study. J. Clin. Oncol. 1998;16:2620–2624
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Miyashiro, I., Takachi, K., Doki, Y. et al. When Is Curative Gastrectomy Justified for Gastric Cancer with Positive Peritoneal Lavage Cytology but Negative Macroscopic Peritoneal Implant?. World J. Surg. 29, 1131–1134 (2005). https://doi.org/10.1007/s00268-005-7703-6
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DOI: https://doi.org/10.1007/s00268-005-7703-6