Prognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer

Abstract

Survival rates after curative gastrectomy for advanced gastric cancer among 238 patients in whom the cancer was invading the serosa were compared with 283 patients without serosal invasion. Generalized Wilcoxon estimates for 5-year survival rate were 47.1 per cent for patients exhibiting serosal invasion and 75.9 per cent for patients without serosal invasion. The frequency of lymph node metastasis increased proportionately with the extent of serosal invasion: 18.4 per cent in cases of S0; 53.8 per cent in cases of S1; 80.0 per cent in cases of S2; and 91.4 per cent in cases of S3. The higher the aggregate total of S (serosal invasion) and n (lymph node metastasis) factors, the lower the 5-year survival rate. In addition, patients with serosal invasion had a propensity for peritoneal dissemination of cancer cells; the percentage of cases with intraperitoneal free cancer cells increased with the extent of serosal invasion. It is worth noting that when cancer infiltration proceeded to the deeper layers and was accompanied by nodal metastasis, cancerous invasion of the perinodal fatty tissue was frequently evident. Therefore, unfavourable prognosis after curative resection in gastric cancer patients with serosal invasion may be largely dependent on whether or not the cancer has invaded the peritoneal cavity and the perinodal fatty tissue.

Prognostic significance of peritoneal washing cytology in Thai patients with gastric adenocarcinoma undergoing curative D2 gastrectomy

“…However, when the tumor invaded the serosa (pT3) and adjacent organs (pT4), the percentages of positive PWC were 19% and 73%, respectively. Previous studies also reported that serosal invasion was associated with a higher likelihood of cytological positivity [2,3,13,21,24]. It seems that the invasion of gastric serosa is a prerequisite for transperitoneal metastasis.…”

“…Peritoneal recurrence is a common cause of death even after curative resection for gastric adenocarcinoma [1][2][3][4][5][6]. This is believed to be due to the presence of malignant cells that have already seeded at the time of operation but cannot be detected macroscopically.…”

Surgical management of gastric perforation in the setting of gastric cancer

“…While many patients who present with perforation are diagnosed with stage IV or non-curable disease, a significant number of patients with stage I-III disease may benefit from curative-intent resection. Spillage of tumor into the peritoneal cavity as a result of perforation was thought to carry a poor prognosis, similar to that of peritoneal disease [14,15]; however, several of the publications in this review argue that peritoneal contamination did not adversely affect survival in these patients [4,9,11].…”

Prognostic impact of PCR-based identification of isolated tumour cells in the peritoneal lavage fluid of gastric cancer patients who underwent a curative R0 resection

“…However, by the conventional cytology, patients with negative cancer cells have occasionally developed recurrent peritoneal disease after surgery, which thus resulted in a low sensitivity of the cytology (Boku et al, 1990;Abe et al, 1995;Schofield et al, 1997;de Manzoni et al, 2006). Almost half of all patients with serosa-invading gastric carcinoma experience peritoneal recurrence even after a curative surgical resection (Martin et al, 2002;Tsuburaya et al, 2005).…”