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. Three-quadrant 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.

Free cancer cells in gastric cancer – methods of detection, clinical and prognostic importance (meta-analysis)

“…Material for cytological examination for IFCCs is usually collected during laparotomy or laparoscopy. Pak et al [23] developed a method of percutaneous peritoneal lavage as the method minimally invasive for a patient. The main aim of the study was to determine the sensitivity and specificity of percutaneous peritoneal lavage and its safety for the patient.…”

Applying Precision Medicine to Ovarian Cancer: Proof-of-Principle for a “Molecular Second Look”

“…Furthermore, our proposed molecular approach to second look could allow for an easier, more minimally invasive method in which percutaneous peritoneal lavage is obtained in an outpatient setting as now proposed for other cancers. 30 Such an alternative NGS-based method would also bypass morbidities associated with general anesthesia and diagnostic laparoscopy and provide an even less invasive procedure.…”

Role of staging laparoscopy in the management of Pancreatic Duct Carcinoma (PDAC): Single‐center experience from a tertiary hospital in Brazil

“…Despite the controversy, PET‐CT is likely to miss subcentimetric lesions that might be detected by laparoscopy . Recently a technique of percutaneous peritoneal lavage for the rapid staging of pancreatic cancer has been described . A high correlation between peritoneal cytology collected through this method and that obtained during staging laparoscopy has been demonstrated.…”

“…42 Recently a technique of percutaneous peritoneal lavage for the rapid staging of pancreatic cancer has been described. 43 A high correlation between peritoneal cytology collected through this minimized potential selection bias. Also, the predictors of metastatic disease at laparoscopy found in this study are in accordance with previous investigations.…”