Impact of preoperative chemotherapy as initial treatment for advanced gastric cancer with peritoneal metastasis limited to positive peritoneal lavage cytology (CY1) or localized peritoneal metastasis (P1a): a multi-institutional retrospective study

e16533 Background: Gastric cancer (GC) with peritoneal metastasis (PM) is associated with a poor prognosis. The free cancer cells are the prerequisite of peritoneal metastasis. Peritoneal lavage cytology (PLC) is the main measure to identify the free cancer cells, but its positive rate is relatively low. This study aims to investigate the association between the result PLC and peritoneal metastasis for GC. Methods: From November 2017 to December 2019, 33 patients with GC were confirmed with PM through computerized tomography or diagnostic laparoscopy. The inflow and outflow catheters were inserted laparoscopically in all patients for postoperative hyperthermic intraperitoneal chemotherapy. PLC was performed with at least 200 ml of fluid and examined by measures of cytology and immunocytopathology. Ascites was aspirated if detected or 500 milliliter of normal saline infused the Douglas cavity, para-colic gutters and the right and left sub-phrenic cavity and then aspirated. Results: There were 15 males and 18 females and the median age was 56 (24-84) years old. All patients had a cT4a/cT4b and an N-positive tumor. The overall positive PLC (PLC+) rate was 63.6% (21/33). The distribution of Lauren classification was respectively 5 (15.2%) intestinal, 26 (78.8%) diffused and 2 (6.1%) mixed tumor. The diffused cases had a higher rate of PLC+ ( P = 0.004). All 5 intestinal GC had a negative PLC (PLC-). 71.4% (20/28) of patients with a grade G3/G4 had a PLC+, compared, no PLC+ was recorded in 5 grade G1/G2 patients (P = 0.003). The median peritoneal carcinomatosis index (PCI) was 14 (1-39). The PLC+ rate was 94.7% (18/19) in PCI > = 10 group and 21.4% (3/14) in PCI < 10 group ( P < 0.001). The median ascites was 200 (0-7000) ml. The PLC+ rate was 88.2% 15/17) in ascites > = 200 ml group and 37.5% (6/16) in ascites < 10 ml ( P = 0.002). The median follow-up was 13(1-27) months and the overall survival was 75.8%, but no significance was detected between PLC+ group and PLC- group. Conclusions: The present study suggested that the result of PLC was not completely coincided with PM for GC by measures of cytology and immunocytopathology, especially for intestinal and grade G1/G2 tumor.

Download Full-text

Role of staging laparoscopy with peritoneal lavage cytology in the treatment of locally advanced gastric cancer

Gastric Cancer ◽

10.1007/s10120-006-0406-3 ◽

2007 ◽

Vol 10 (1) ◽

pp. 29-34 ◽

Cited By ~ 68

Author(s):

Satoru Nakagawa ◽

Atsushi Nashimoto ◽

Hiroshi Yabusaki

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Peritoneal Lavage ◽

Locally Advanced ◽

Staging Laparoscopy ◽

Peritoneal Lavage Cytology ◽

Locally Advanced Gastric Cancer ◽

Lavage Cytology

Download Full-text

Intraoperative peritoneal lavage cytology offers prognostic significance for gastric cancer patients with curative resection

Cancer Science ◽

10.1111/cas.13219 ◽

2017 ◽

Vol 108 (5) ◽

pp. 978-986 ◽

Cited By ~ 6

Author(s):

Eiji Higaki ◽

Shinya Yanagi ◽

Naoto Gotohda ◽

Takahiro Kinoshita ◽

Takeshi Kuwata ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Curative Resection ◽

Peritoneal Lavage ◽

Prognostic Significance ◽

Peritoneal Lavage Cytology ◽

Lavage Cytology ◽

Gastric Cancer Patients

Download Full-text

Survival and prognosticators of gastric cancer patients with only positive peritoneal lavage cytology.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.16 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 16-16

Author(s):

Kazuki Kano ◽

Tsutomu Sato ◽

Yukio Maezawa ◽

Kenki Segami ◽

Tetsushi Nakajima ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Proportional Hazards Model ◽

Peritoneal Lavage ◽

Multivariate Analyses ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Peritoneal Cytology ◽

Peritoneal Lavage Cytology ◽

Lavage Cytology

16 Background: Treatment strategies for only positive peritoneal lavage cytology findings have not yet been established. The objective of this retrospective study was to clarify the survival and prognosticators in these patients. Methods: Overall survival (OS) rates were examined in 39 patients with gastric cancer who underwent a curative resection and had positive peritoneal cytology in the absence of overt peritoneal metastases between January 2000 and June 2015. Univariate and multivariate analyses were performed to identify risk factors using a Cox proportional hazards model. Results: A total of 39 patients were evaluated. The median overall survival was significantly longer in the 34 patients who received chemotherapy after surgery than that in the 5 who did not (19.1 vs 5.9 months, p < 0.01). Among the patients who received chemotherapy after surgery, univariate and multivariate analyses showed that pN3b was an independent significant prognosticator (hazard ratio of 4.169 with 95% CI: 1.108-15.684, p = 0.035). The median OS was 15.8 months when the patients diagnosed with N3b was 33.1 months when the patients diagnosed with N3a or lower. Conclusions: The prognosis of gastric carcinoma with positive peritoneal lavage cytology without peritoneal metastasis is still poor and need more aggressive treatment. The lymph node metastasis was a significant prognosticator in these patients.

Download Full-text