Percutaneous Peritoneal Lavage for the Rapid Staging of Gastric and Pancreatic Cancer

Abstract

Background-Positive peritoneal cytology (PC) is classified as M1 disease in gastric and pancreatic cancer. While PC is typically obtained by laparoscopic peritoneal lavage (PL), this study sought to examine the feasibility and safety of performing this percutaneously, with monitored anesthesia care and in combination with other diagnostic procedures to condense and expedite the staging process. Methods-Patients with gastric or pancreatic cancer scheduled for laparoscopy with PL were prospectively enrolled to undergo intraoperative percutaneous PL prior to laparoscopic PL. Saline was infused through a percutaneously-inserted catheter and fluid was collected for PC. Threequadrant washings collected during laparoscopy were also sent for PC. The primary outcome was to evaluate the sensitivity and specificity of percutaneous PL for detecting positive PC compared with the gold standard of laparoscopic PL. The secondary outcome was to determine safety. Results-Percutaneous PL was successfully performed in 70 of 76 patients (92%). Ten of 48 gastric cancer patients (21%) and three of 22 pancreatic cancer patients (14%) had positive percutaneous and laparoscopic PC. Two additional gastric cancer patients had positive laparoscopic PC only. Sensitivity and specificity of percutaneous compared to laparoscopic PL was 87% and 100%, respectively. No complications occurred with percutaneous PL. Conclusions-Percutaneous PL is a safe and effective minimally-invasive alternative to laparoscopic PL for the diagnosis of metastatic gastric and pancreatic cancer. It is possible this can be utilized in an outpatient setting, such as during endoscopy, to allow for earlier diagnosis of M1 disease and decreased time to appropriate treatment.