Yield of peritoneal cytology in staging patients with gastric and gastroesophageal cancer

Abstract

Background Guidelines for gastric and gastroesophageal (GE) cancer recommend staging laparoscopy (SL) with peritoneal cytology (PC). However, the reliability of PC is unknown. The primary purpose of this study was to determine the sensitivity of PC. Methods We analyzed a prospectively maintained database of patients who underwent SL and PC for gastric and GE cancer. Test sensitivity of PC for detecting peritoneal disease was assessed. Survival analyses were used to examine the implication of PC. Results There were 1186 patients that underwent SL and PC; 282 (24%) were found with carcinomatosis. PC was analyzed in 214 (76%) of these patients and 77 (36%) were found to have no malignant cells. In this setting, PC had a sensitivity of 64% for confirming peritoneal disease. Those with peritoneal disease had a poorer 5‐year overall survival (5.8% vs 37.7%; P < .001). Those with positive PC without carcinomatosis had a similar survival to those with gross disease with and without cytological confirmation (both P > .05). Conclusions PC has limited sensitivity for detecting peritoneal disease. Positive PC alone carries a similar poor survival as in patients with gross carcinomatosis. Improvements in the identification of microscopic disease in peritoneal washings are needed.

Staging laparoscopy and peritoneal cytology in patients with early stage gastric adenocarcinoma

“…At times, patients with T1 lesions will undergo SL and PC if there are high-risk features, or at the time of laparotomy and attempted resection. SL and PC were performed prior to any definitive treatment with the standard technique used at our institution, as previously described [5,6,[16][17][18][19][20]. The peritoneal cavity was inspected for gross evidence of metastasis.…”

Tumor characteristics and clinical outcome of peritoneal metastasis of gastric origin treated with a hyperthermic intraperitoneal chemotherapy procedure in the PERISCOPE I trial

“…Peritoneal dissemination is common in gastric cancer. About 14%–24% of the newly diagnosed patients have peritoneal metastases at the time of diagnosis 1‐3 . In about 9% of the newly diagnosed patients with gastric cancer, the peritoneum is the only location for metastases.…”

Survey and literature review on the importance of peritoneal cytology in staging and treatment of gastric cancer: always wash it before you treat it

“…Recommendations A, B and C are related to initial staging prior to any treatment, while 1 and 2 address reassessment after neoadjuvant therapy. Higher volumes (500–1000 mL) of lavage should be used to increase sensitivity 6,8,9 PCO negative (PCO−), no PM: Curative treatment with neoadjuvant chemotherapy, restaging computed tomography scan, curative surgery and adjuvant chemotherapy. PM present (notwithstanding PCO status): Treatment with palliative intent.…”