The critical role of peritoneal cytology in the staging of gastric cancer: An evidence‐based review

Abstract

Positive peritoneal cytology (Cyt+) is an important staging tool for patients with locally advanced gastric cancer. The objective of this review is to evaluate the current literature regarding cytology evaluation in patients with gastric cancer and to provide recommendations on the inclusion of this powerful prognosticator in patients with this disease. A literature search was performed for recent and pertinent studies evaluating peritoneal cytology in patients with gastric adenocarcinoma. Peritoneal cytology as the only evidence for M1 disease is present in up to 10% of patients with locally advanced gastric cancer; survival in the setting of Cyt+ is dismal when gastrectomy is the first line of therapy. Improved survival is associated with response to chemotherapy indicated by conversion to negative cytology, good performance status, and antral tumors. Highly select patients with Cyt+ treated with gastrectomy show improved survival in only some of the available studies. There are high quality studies that support the routine practice of peritoneal cytology evaluation in patients with locally advanced gastric cancer. The role of gastrectomy remains unclear in patients with Cyt+ and clinical trials are needed to define the best treatment option for this select group of patients.

Influence of Surgical Resection of Hepatic Metastases From Gastric Adenocarcinoma on Long-term Survival

“…The prognosis in patients with positive peritoneal cytology or peritoneal metastasis is rather poor and no survival benefits have been observed with surgical resection. 56,57 The biological basis for the pattern of recurrence is different between hepatic and peritoneal disease. 58 Although the results of this review appear to parallel what has been observed in the resection of hepatic metastases from colorectal cancer, where the surgical approach is more widely practiced, 59 the analysis in gastric adenocarcinoma should be viewed with caution, as the current study has several limitations.…”

Regional but fatal: Intraperitoneal metastasis in gastric cancer

“…Although conventional peritoneal cytology is the standard and reliable method for detecting free cancer cells in the peritoneal wash and for predicting peritoneal metastasis, in large-sample studies, approximately 4%-11% of patients will have cytology positive and therefore it is not practical or cost-effective to perform it in all patients[62]. Furthermore, it lacks sensitivity for the detection of residual cancer cells and prediction of peritoneal spread[63,64].…”

Integrated fluorescent cytology with nano‐biologics in peritoneally disseminated gastric cancer

“…This system would instead be useful in combination with conventional cytology when treating patients after surgery. After staging laparoscopy in particular, it is important to decide which type of anti‐cancer drug is suitable for each patient from the point of conversion chemotherapy . Second, the present sample size was relatively small, and patient background was not uniform.…”