Cytology of Peritoneal Lavage Performed During Staging Laparoscopy for Gastrointestinal Malignancies: Is It Useful?

Dijkum, E. J. Nieveen van; Sturm, Patrick; Wit, L. T. de; Offerhaus, Johan; Obertop, H.; Gouma, D.J.

doi:10.1097/00000658-199812000-00002

Cited by 45 publications

(31 citation statements)

References 20 publications

(5 reference statements)

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“…But the role of cytology during laparoscopy in advanced gastric cancer is controversial. In previous reports, cytology during laparoscopy provided no additional information compared to laparoscopy fi ndings alone [5,6].…”

Section: Introductionmentioning

confidence: 97%

Role of staging laparoscopy with peritoneal lavage cytology in the treatment of locally advanced gastric cancer

2007

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Background. More accurate preoperative staging is necessary to determine the treatment strategy for locally advanced gastric cancer. Laparoscopy has been suggested as an appropriate staging modality. The aim of this study was to clarify the role of staging laparoscopy in patients with locally advanced gastric cancer. Methods. One hundred patients with primary gastric adenocarcinoma underwent laparoscopy with peritoneal lavage cytology. The disease stages determined were compared with those obtained by conventional methods. Results. The disease stages were corrected after laparoscopy for 47 of the 100 patients (47%), with downstaging in 3 (3.0%) and upstaging in 44 (44%). Peritoneal deposits were found in 7 patients with peritoneal dissemination diagnosed by conventional examination. An unsuspected peritoneal deposit was found in 21 of 93 patients (22.6%), and unsuspected free cancer cells without deposits were found in 27 of 93 patients (29.0%). Gastrectomy after staging laparoscopy was performed in 39 patients. Laparoscopy showed no peritoneal deposits in any of these patients. Free cancer cells were found in 9 patients (23.1%), but 4 of these had peritoneal deposits at operation. R0 resection was performed in 34 of the 39 patients (87.2%). Neoadjuvant chemotherapy after staging laparoscopy was performed in 35 patients. All 35 patients underwent gastrectomy, which resulted in 27 R0 and 8 R2 resections. Of 18 patients with positive cytology at laparoscopy, 11 had no free cancer cells at operation. Neoadjuvant chemotherapy induced downstaging of the disease in 11 of the 18 patients with positive cytology (61.1%). Of 26 patients with massive peritoneal deposits, 4 underwent palliative resection because of pyloric stenosis. Twenty-two patients (22.0%) were able to avoid unnecessary laparotomy because of the staging laparoscopy. Conclusion. Staging laparoscopy with peritoneal lavage cytology is a safe, effective tool in patients with locally advanced gastric cancer, especially in patients receiving neoadjuvant chemotherapy.

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Section: Introductionmentioning

confidence: 97%

Role of staging laparoscopy with peritoneal lavage cytology in the treatment of locally advanced gastric cancer

2007

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“…More importantly, disseminated cancer cells can progress independently from the primary tumor (37), so analysis of micrometastases has high potential for further understanding of carcinogenesis and practical use of these cells for diagnostic and prognostic purposes (38)(39)(40). However, existing direct microscopybased morphological methods for cancer detection, especially detection of low number of disseminated cancer cells in body fluids were proven to have extremely low sensitivity (3,6,(13)(14). Another problem is that the final conclusion about a malignant status of detected cells entirely depends on the expertise and opinion of the pathologist.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the timely and sensitive detection of free cancer cells at the earliest possible stage is critical to predict relapse before clinical manifestation, be-cause it can potentially improve and optimize the disease management and treatment strategy. However, currently used direct microscopic detection of disseminated cells in body fluids on the basis of routine morphological criteria has very low sensitivity, with positive findings in about 4% to 13% of GI cancer cases (3,(13)(14). Such a low sensitivity of the peritoneal cytology, in particular, makes positive findings only a determinant of the stage IV GI cancer cases with poorest prognosis, and only 2% of the 5-year survival rate (9,15).…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Telomerase Activity in Peritoneal Disseminated Cells: Gastrointestinal Cancers

Botchkina

Rivadeneira

Watkins

et al. 2008

Mol Med

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Early detection and accurate staging of gastrointestinal (GI) cancers are difficult. The aim of this study was to evaluate whether telomerase activity (TA) in exfoliated/disseminated epithelial cells could be used as a reliable marker for GI cancers. TA was evaluated with the real-time RTQ-TRAP in immunomagnetically sorted peritoneal epithelial cells from 60 patients undergoing surgical treatment. Thirty-two patients were clinically diagnosed with a variety of GI cancers: 1 had premalignant disease, 2 had history of GI cancers, and 25 patients were clinically negative for cancer. Here we report that all types and all cases of gastrointestinal cancers were telomerase positive, thereby demonstrating 100% sensitivity for cancer. Eighteen of 25 nonmalignant cases had undetectable levels of TA, 2 had low, and 5 of 25 expressed high TA levels. Because normal epithelial cells usually have low TA and a lesser tendency to exfoliate compared with cancer cells, it is of great importance to have close follow-up for these patients to exclude possible malignant disease. We conclude that RTQ-TRAP assessment of TA in immunomagnetically sorted peritoneal epithelial cells has 100% sensitivity and 100% negative predictive value for GI cancers, and therefore, can be considered as a valuable tool and useful addition to current standard diagnostic methods. Clinical significance of unusually high telomerase activity in some clinically negative for cancer cases requires further study.

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“…The current AJCC classification stages positive peritoneal cytology as stage IV disease with median survival reported between 6 and 12 mo. Positive cytology rates in those presenting with radiographically resectable disease vary and range from 3% to 10% of cases [18,19,21] . In our experience, patients who have undergone resection in the setting of positive peritoneal cytology and absence of other identifiable metastatic disease had a similar survival as patients with stage Ⅳ disease [22] .…”

Section: Adenocarcinomamentioning

confidence: 99%

“…In our experience, patients who have undergone resection in the setting of positive peritoneal cytology and absence of other identifiable metastatic disease had a similar survival as patients with stage Ⅳ disease [22] . Nevertheless, the utility of peritoneal cytology remains controversial [21] and, overall, many remain reluctant not to perform resection when the tumor is resectable and without macroscopic metastatic disease.…”

Section: Adenocarcinomamentioning

confidence: 99%

Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy

Gaujoux

Allen

2010

WJGS

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Even after extensive preoperative assessment, staging laparoscopy may allow avoidance of non-therapeutic laparotomy in patients with radiographically occult metastatic or locally unresectable disease. Staging laparoscopy is associated with decreased postoperative pain, a shorter hospital stay and a higher likelihood of receiving systemic therapy compared to laparotomy but its yield has decreased with improvements in imaging techniques. Current uses of staging laparoscopy include the following: (1) In the staging of pancreatic adenocarcinoma, laparoscopic staging allows for the identification of sub-radiographic metastatic disease in locally advanced cancer in approximately 30% of patients and, in radiographically resectable cancer, may identify metastatic disease in 10%-15% of cases; (2) In colorectal liver metastases, selective use of laparoscopic staging in patients with a clinical risk score of over 2 identifies unresectable disease in approximately 20% of patients; (3) In hepatocellular carcinoma, laparoscopic staging could be selectively used in high-risk patients such as those with clinically apparent liver cirrhosis and in patients with major vascular invasion or bilobar tumors; and (4) In biliary tract malignancy, staging laparoscopy may be used in all patients with potentially resectable primary gallbladder cancer and in selected patients with T2/T3 hilar cholangiocarcinoma. Because of the decreasing yield of SL secondary to improvements in imaging techniques, staging laparoscopy should be used selectively for patients with pancreatic and hepatobiliary malignancy to avoid unnecessary non-therapeutic laparotomy and to improve resource utilization. Each individual surgeon should apply his or her threshold as to whether staging laparoscopy is indicated according to the quality of preoperative imaging studies and the availability of resources at their own institution.

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Cytology of Peritoneal Lavage Performed During Staging Laparoscopy for Gastrointestinal Malignancies: Is It Useful?

Cited by 45 publications

References 20 publications

Role of staging laparoscopy with peritoneal lavage cytology in the treatment of locally advanced gastric cancer

Role of staging laparoscopy with peritoneal lavage cytology in the treatment of locally advanced gastric cancer

Clinical Significance of Telomerase Activity in Peritoneal Disseminated Cells: Gastrointestinal Cancers

Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy

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