scholarly journals TP6.2.15 Staging Laparoscopy and Peritoneal Cytology for Gastric and Gastro-oesophageal Junction Malignancy: an Audit from a Single Oesophagogastric Resection Centre

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hollie Alice Clements ◽  
Sukitha Namal Rupasinghe ◽  
Mushfique Alam ◽  
Kieran Murphy ◽  
Rohith Rao
Keyword(s):  
Current Practice ◽  
Staging Laparoscopy ◽  
Gastric Disease ◽  
Peritoneal Cytology ◽  
Positive Cytology ◽  
T Stage ◽  
Change In Practice ◽  
Current Threshold ◽  
Positive Peritoneal Cytology ◽  
The Impact

Abstract Aims AUGIS recommends staging laparoscopy in all gastric cancers and selected gastro-oesophageal junction (GOJ) cancers. We previously audited our practice of staging laparoscopy and peritoneal cytology and found that in a cohort of 158 consecutive patients, no tumours less than T3 with negative nodes had positive cytology, resulting in change in practice to selectively use peritoneal cytology in patients with a T-stage of 3 and above or N+ disease. Our aim was to assess the impact of this audit on current practice. Methods We retrospectively reviewed the notes of patients undergoing staging laparoscopy and oesophagogastroduodenoscopy (OGD) identified by MDT from January 2019 to December 2019. Patients who underwent resection on the same day were excluded. Results 63 patients underwent staging laparoscopy and OGD, 54 for GOJ and 9 for gastric disease. The majority were staged as T3 or T4a (81%). As a result of staging laparoscopy and OGD, 4 (6%) patients were changed from curative to palliative pathway, 2 (3%) of whom had positive cytology. No patients had positive peritoneal cytology for a T stage of 2 and below with no positive nodes, further demonstrating the safety of the recommendation. Conclusions Peritoneal cytology has a low yield in changing the clinical course of patients but can upstage up to 6% of patients. The re-audit backs up the previous guidance in the safety of using our current threshold for recommending peritoneal cytology and potentially prevents delaying treatment while waiting for cytology results.

Does Neoadjuvant Treatment for Gastric Cancer Patients with Positive Peritoneal Cytology at Staging Laparoscopy Improve Survival?

2008 ◽  
Vol 15 (10) ◽  
pp. 2684-2691 ◽  
Author(s):  
Brian Badgwell ◽  
Janice N. Cormier ◽  
Sunil Krishnan ◽  
James Yao ◽  
Gregg A. Staerkel ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Neoadjuvant Treatment ◽  
Staging Laparoscopy ◽  
Peritoneal Cytology ◽  
Positive Peritoneal Cytology ◽  
Gastric Cancer Patients

Analysis Of Risk Factors Of Positive Peritoneal Cytology In Patients Treated For Gastric Cancer – Preliminary Report*

2015 ◽  
Vol 87 (10) ◽  
Author(s):  
Radosław Lisiecki ◽  
Arkadiusz Spychała ◽  
Katarzyna Pater ◽  
Dawid Murawa
Keyword(s):  
Gastric Cancer ◽  
Surgical Treatment ◽  
Cancer Cells ◽  
Peritoneal Cavity ◽  
Peritoneal Metastases ◽  
Histological Type ◽  
Gastric Body ◽  
Peritoneal Cytology ◽  
Positive Cytology ◽  
Positive Peritoneal Cytology

AbstractPresence of free gastric cancer cells in the peritoneal cavity of patients who underwent surgical treatment for gastric cancer is a negative prognostic factor and caused rapid disease recurrence, manifested as peritoneal metastases.Positive peritoneal cytology despite lack of visible peritoneal metastases was regarded as M1 class in the TNM classification (7was to analyze factors associated with positive peritoneal cytology and identify groups of patients in whom diagnostic laparoscopy plus peritoneal lavage in the diagnostic process could affect therapeutic decisions.The study enrolled patients with gastric cancer who underwent surgical treatment at the Department of Surgery, Wielkopolskie Oncology Center in Poznań. During the laparotomy, after opening of the peritoneal cavity, 200 ml of physiological saline at 37°C was administered in the tumor region. After this fluid was mixed, 100 ml of lavage fluid was collected. This fluid was subsequently spun many times to obtain sediment for cytology and immunohistochemistry investigation using anti-BerEp-4, CK 7/20, and B72.3.Results of peritoneal cytology were analyzed jointly with clinical factors – patient’s age, sex and pathology factors – tumor invasion, involvement of lymph nodes, histological grade, histological type according to Lauren and localization of the cancer in the stomach.Analysis of the peritoneal fluid for presence of free cancer cells was done in 51 patients. Positive peritoneal cytology was found in 12 (23.5%) patients. In the group of patients with positive cytology, all patients had T3/T4 tumors and all were found to have lymph node metastases, while G3 cancer was found in 83.3% of patients. In patients with positive cytology, diffuse gastric cancer according to Lauren predominated (9 of 12 patients, 75%), while in patients with negative cytology – intestinal type (20 of 39 patients, 51.2%). In the group of patients with positive histology, the whole stomach was involved by the cancer process in 7 of 12 patients (58.3%), while in the group with negative histology, in 29 of 39 patients the tumor was located in the gastric body and prepyloric part (74.4%).Based on this study we can conclude that determinants of positive peritoneal cytology include: tumor stage T3/T4, N+, G3, cancer located in the whole stomach, diffuse histological type according to Lauren.

The impact of multimodality treatment on outcomes of patients with type II endometrial carcinoma: A single institution experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16552-e16552
Author(s):  
Shobhana Talukdar ◽  
Michelle Jankowski ◽  
Rabbie Kriakoss Hanna ◽  
Mohamed A. Elshaikh
Keyword(s):  
Lymph Nodes ◽  
Endometrial Carcinoma ◽  
Multimodality Treatment ◽  
Serous Carcinoma ◽  
Adjuvant Chemoradiotherapy ◽  
Peritoneal Cytology ◽  
Adjuvant Radiation ◽  
Type Ii ◽  
Positive Peritoneal Cytology ◽  
The Impact

e16552 Background: To determine the impact of different adjuvant treatment modalities on relapse-free (RFS), disease-specific (DSS) and overall survival (OS) of patients with type II endometrial carcinoma after hysterectomy. Methods: Our prospectively-maintained database of 1605 uterine cancer patients was reviewed for this IRB-approved study. We identified 167 consecutive patients with type II endometrial carcinoma 2009 FIGO stages IA-IIIC2 who underwent hysterectomy between 1991-2012. Recurrence-free survival (RFS), DSS and OS was calculated from the date of hysterectomy using the Kaplan Meier method. Cox regression modeling was used to explore the risks of various factors on recurrence. Results: Median follow-up was 5.4 years. Median age was 65 years. All patients underwent hysterectomy and salpingo-oophorectomy. 95% had peritoneal cytology and 87% underwent lymphadenectomy. 61% were stage I, 11% with stage II and 28% with stage III (including 33 patients with lymph node involvement). There were 60% of patients with uterine serous carcinoma, 22% with clear cell and 18% with a mixed histology. 29% of patients received adjuvant chemoradiotherapy, 25% received either chemotherapy or radiothereapy alone and 21% were managed with close surveillance. 5-year OS, DSS and RFS was 54%, 64% and 54%, respectively. On multivariate analysis and after adjusting for other prognostic factors, multimodality treatment, (p = 0.0076) presence of LVSI (p = 0.0443), lower uterine segment involvement (p = 0.0003) and involvement of lymph nodes (p = 0.001) were the only independent predictors of RFS. These factors in addition to positive peritoneal cytology were also significant predictors of DSS. Age at diagnosis, the presence of LVSI, positive lymph nodes, positive peritoneal cytology and adjuvant multimodality treatment were the only predictors of OS with p = 0.0251, 0.0178, 0.003, 0.0019 and 0.046, respectively. Conclusions: In this hospital-based study, adjuvant radiation treatment combined with chemotherapy was independent predictor of RFS, DSS and OS compared to single modality treatment. These findings need validation from a prospective randomized study.

The role of staging laparoscopy in type 4 gastric cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 35-35
Author(s):  
Norihiko Sugisawa ◽  
Etsuro Bando ◽  
Yuichiro Miki ◽  
Rie Makuuchi ◽  
Hironobu Goto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Metastasis ◽  
Invasive Procedure ◽  
Staging Laparoscopy ◽  
Peritoneal Cytology ◽  
Clinical Imaging ◽  
Surgical Interventions ◽  
Peritoneal Lavage Cytology ◽  
Positive Peritoneal Cytology

35 Background: In type 4 gastric cancer, the incidence of peritoneal metastasis which was unexpectedly found during surgery was as high as 40 percent. It is very difficult to detect peritoneal metastasis in clinical imaging such as computed tomography or ultrasound before operation. Staging laparoscopy (SL) is considered to be an only minimal invasive procedure to detect peritoneal metastasis. However, the significance of SL had not yet been fully elucidated. The aim of this study is to assess the role of SL in type 4 gastric cancer. Methods: From September 2002 to March 2012, a total of 169 patients with type 4 gastric cancer who were diagnosed as not having distant metastasis in clinical imaging were enrolled in this study. SL was performed for 56 patients, and the other 113 patients underwent open laparotomy (OL) without SL. We retrospectively examined the incidence of peritoneal metastasis and positive peritoneal cytology and treatment courses in patients who underwent SL and OL. Results: In 56 patients undergoing SL, 23 (41%) had peritoneal metastasis and 40 (71%) had positive peritoneal cytology. Similarly, 54 (48%) had peritoneal metastasis and 86 (76%) had positive peritoneal cytology in 113 patients undergoing OL. There were no significant differences of the incidence of peritoneal metastasis and positive peritoneal cytology between the two groups. Subsequent treatments after SL or OL were diverse depends on patients condition and participating clinical trials, however, 17 (32%) in SL group and 13 (12%) in OL group were treated without surgical interventions. There was no morbidity and mortality in both SL group and OL group. In SL group, open surgery was performed soon afterword in 39 patients. Among them, 2 patients was failed to detect peritoneal metastasis by SL. Therefore the accuracy of detecting peritoneal metastasis in SL was 23/25 (92%). Conclusions: In type 4 gastric cancer, the incidence of peritoneal metastasis was around 40% and positive peritoneal lavage cytology was around 70% in both SL and OL. As SL is less invasive than OL, SL appears to be a useful way to detect peritoneal seeding and establish treatment strategy in patients with type 4 gastric cancer.

A phase II study of laparoscopic hyperthermic intraperitoneal chemoperfusion (HIPEC) for gastric carcinomatosis or positive cytology.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. TPS186-TPS186 ◽  
Author(s):  
Brian D. Badgwell ◽  
Mariela A. Blum ◽  
Prajnan Das ◽  
Elena Elimova ◽  
Paul F. Mansfield ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Clinical Trial ◽  
Systemic Chemotherapy ◽  
Survival Rates ◽  
Exploratory Laparotomy ◽  
Gastric Disease ◽  
Peritoneal Cytology ◽  
Positive Cytology ◽  
Invasive Approach ◽  
C 30

TPS186 Background: Over the last 2 decades, intraperitoneal chemotherapy has been found to have activity for select subgroups of patients with carcinomatosis from colon, ovarian, appendiceal, and recently, gastric origins. However, there is little data to support an aggressive surgical approach of cytoreduction (debulking) and HIPEC for patients with gastric cancer and positive cytology or carcinomatosis. The morbidity and mortality rates of cytoreduction and HIPEC, in combination with gastrectomy, are significant and the survival rates of this approach may not extend beyond that of treatment with systemic chemotherapy. The purpose of this clinical trial, therefore, is to perform HIPEC in a neoadjuvant fashion via a minimally invasive approach without cytoreduction for patients with gastric cancer and positive cytology or low volume carcinomatosis. Patients found to have resolution of all extra-gastric disease will then be candidates for gastrectomy. Methods: Patients with gastric and gastroesophageal adenocarcinoma and positive peritoneal cytology or radiologically-occult carcinomatosis that have completed treatment with systemic chemotherapy are offered participation in the study. Type and duration of systemic chemotherapy is left to the discretion of the treating medical oncologist. Laparoscopic HIPEC consists of Mitomycin C 30 mg and Cisplatin 200 mg in 3-7 liters of infusate circulated using an extracorporeal circulation device at a flow rate of 700-1500 mL/minute for 60 minutes, performed no sooner than 3 weeks after completion of systemic chemotherapy. The Laparoscopic HIPEC procedure may be performed up to 5 times, with a minimum of 3 weeks between procedures. After laparoscopic HIPEC, subjects whose disease did not progress will proceed to surgery with diagnostic laparoscopy and possibly exploratory laparotomy to assess resectability, and if their cancer is resectable will undergo gastrectomy. After completion of study–related treatment, subjects will be followed until recurrence and/or death for up to five years. Fourteen of planned 30 patients have been enrolled (NCI-2014-01105). Clinical trial information: NCI-2014-01105.

scholarly journals The Current Role of Staging Laparoscopy in Oesophagogastric Cancer

2015 ◽  
Vol 97 (2) ◽  
pp. 146-150 ◽  
Author(s):  
L Convie ◽  
RJ Thompson ◽  
R Kennedy ◽  
WDB Clements ◽  
PD Carey ◽  
...  
Keyword(s):  
Gastric Adenocarcinoma ◽  
Preoperative Staging ◽  
Squamous Carcinoma ◽  
Staging Laparoscopy ◽  
Oesophageal Adenocarcinoma ◽  
Peritoneal Cytology ◽  
Peritoneal Disease ◽  
Curative Intent ◽  
Significant Difference ◽  
Positive Peritoneal Cytology

Introduction Oesophagogastric cancers are known to spread rapidly to locoregional lymph nodes and by transcoelomic spread to the peritoneal cavity. Staging laparoscopy combined with peritoneal cytology can detect advanced disease that may not be apparent on other staging investigations. The aim of this study was to determine the current value of staging laparoscopy and peritoneal cytology in light of the ubiquitous use of computed tomography in all oesophagogastric cancers and the addition of positron emission tomography in oesophageal cancer. Methods All patients undergoing staging laparoscopy for distal oesophageal or gastric cancer between March 2007 and August 2013 were identified from a prospectively maintained database. Demographic details, preoperative staging, staging laparoscopy findings, cytology and histopathology results were analysed. Results A total of 317 patients were identified: 159 (50.1%) had gastric adenocarcinoma, 136 (43.0%) oesophageal adenocarcinoma and 22 (6.9%) oesophageal squamous carcinoma. Staging laparoscopy revealed macroscopic metastases in 36 patients (22.6%) with gastric adenocarcinoma and 16 patients (11.8%) with oesophageal adenocarcinoma. Positive peritoneal cytology in the absence of macroscopic peritoneal metastases was identified in a further five patients with gastric adenocarcinoma and six patients with oesophageal adenocarcinoma. There was no significant difference in survival between patients with macroscopic peritoneal disease and those with positive peritoneal cytology (p=0.219). Conclusions Staging laparoscopy and peritoneal cytology should be performed routinely in the staging of distal oesophageal and gastric cancers where other investigations indicate resectability. Currently, in our opinion, patients with positive peritoneal cytology should not be treated with curative intent.

scholarly journals Intraperitoneal Administration of Paclitaxel Combined with S-1 Plus Oxaliplatin as Induction Therapy for Patients with Advanced Gastric Cancer with Peritoneal Metastases

2020 ◽  
Author(s):  
Shin Saito ◽  
Hironori Yamaguchi ◽  
Hideyuki Ohzawa ◽  
Hideyo Miyato ◽  
Rihito Kanamaru ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Survival Time ◽  
Induction Chemotherapy ◽  
Intraperitoneal Administration ◽  
Peritoneal Metastases ◽  
Staging Laparoscopy ◽  
Peritoneal Cytology ◽  
Positive Peritoneal Cytology ◽  
Grade 3

Abstract Background Intraperitoneal (IP) administration of paclitaxel (PTX) has a great pharmacokinetic advantage to control peritoneal lesions and can be combined with various systemic chemotherapies. In this study, we evaluate the efficacy and tolerability of a combination of IP-PTX and systemic S-1/oxaliplatin (SOX) for induction chemotherapy for patients with peritoneal metastases (PM) from gastric cancer (GC). Patients and Methods Patients with GC who were diagnosed as macroscopic PM (P1) or positive peritoneal cytology (CY1) by staging laparoscopy between 2016 and 2019 were enrolled. PTX was IP administered at 40 mg/m2 on days 1 and 8. Oxaliplatin was IV administered at 100 mg/m2 on day 1, and S-1 was administered at 80 mg/m2/day for 14 consecutive days, repeated every 21 days. Survival time and toxicities were retrospectively explored. Results Forty-four patients received SOX + IP-PTX with a median (range) of 16 (1–48) courses, although oxaliplatin was suspended due to the hematotoxicity or intolerable peripheral neuropathy in many patients. The 1-year overall survival (OS) rate was 79.5% (95% CI 64.4–88.8%) with median survival time of 25.8 months. Gastrectomy was performed in 20 (45%) patients who showed macroscopic shrinkage of PM with a 1-year OS rate of 100% (95% CI 69.5–100%). Grade 2 and 3 histological responses was achieved in four (20%) and one (5%) patients. Grade 3/4 toxicities included neutropenia (11%), leukopenia (39%), and anemia (14%). There were no treatment-related deaths. Conclusions Combination chemotherapy using SOX + IP-PTX regimen is highly effective and recommended as induction chemotherapy for patients with PM from GC.

S-1 and intraperitoneal and intravenous paclitaxel as neoadjuvant chemotherapy for gastric cancer with positive peritoneal cytology.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 142-142
Author(s):  
Y. Peng ◽  
M. Imano ◽  
H. Imamoto ◽  
K. Nishiki ◽  
Y. Nakamori ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Survival Rates ◽  
Complete Response ◽  
Staging Laparoscopy ◽  
Peritoneal Cytology ◽  
Second Look ◽  
Progression Of Disease ◽  
Positive Peritoneal Cytology ◽  
Grade 3

142 Background: The prognosis of gastric cancer with positive peritoneal cytology is dismal. Standard treatments for these patients have not been established. The purpose of this study was to evaluate the safety and response of the regimen. Methods: Patients who were diagnosed with advanced gastric cancer between 2007 and 2010 underwent staging laparoscopy and received intraperitoneal paclitaxel when peritoneal cytology were positive and sequential systemic chemotherapy, S-1 combined with intravenous paclitaxel within 14 days after staging laparoscopy. Paclitaxel was administered intraperitoneally at 80 mg/m2. S-1 was administered at 80 mg/m2/day for 14 consecutive days, followed by 7 days rest. Paclitaxel was administered intravenously at 50 mg/m2 on day 1 and day 8. After 2 courses of S-1 combined with paclitaxel were administered, clinical response was assessed by gastroendoscopy and computed tomography. Additional 2 or 3 courses were administered unless progression of disease was proved. Patients who achieved complete response (CR) or partial response (PR) and patients with stable disease (SD) underwent second-look laparoscopy following gastrectomy when peritoneal cytology turned negative. Results: 8 (7 male, 1 female) patients were enrolled: median age was 64 years (range 40-75). Of 8 patients, 1 patient achieved CR, and 5 PR. 2 patients showed progressive disease (PD). Grade 3 neutropenia occurred in 1 patient. 6 patients underwent second-look laparoscopy and peritoneal cytology turned negative in all 6 patients. Total or distal gastrectomy with lymphnode dissection was performed consecutively in 3 or 3 patients, respectively. Median follow-up duration was 775 days (range 187-1,028). No recurrence has not been observed, while the 1-year and 2-year survival rates of 14 patients with peritoneal cytology positive gastric cancer who have not received neoadjuvant chemotherapy were 58.3% and 33.3%, respectively. Conclusions: S-1, intraperitoneal and intravenous paclitaxel as neoadjuvant chemotherapy seems to be a effective strategy against gastric cancer with positive peritoneal cytology. No significant financial relationships to disclose.

scholarly journals The impact of positive peritoneal cytology on prognosis in patients with cervical cancer: a meta-analysis

2015 ◽  
Vol 113 (4) ◽  
pp. 595-602 ◽  
Author(s):  
Sang-Hee Yoon ◽  
Soo-Nyung Kim ◽  
Seung-Hyuk Shim ◽  
Ji-Young Lee ◽  
Sun-Joo Lee ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Meta Analysis ◽  
Peritoneal Cytology ◽  
Positive Peritoneal Cytology ◽  
The Impact

Translating Principles of Speech Science to Clinical Practice: Current and Future Trends in Craniofacial Disorders

2008 ◽  
Vol 18 (1) ◽  
pp. 31-40 ◽  
Author(s):  
David J. Zajac
Keyword(s):  
Clinical Practice ◽  
Speech Intelligibility ◽  
Current Practice ◽  
Computer Assisted ◽  
Behavioral Management ◽  
Single Word ◽  
Future Directions ◽  
Speech Science ◽  
The Impact ◽  
Opinion Article

Abstract The purpose of this opinion article is to review the impact of the principles and technology of speech science on clinical practice in the area of craniofacial disorders. Current practice relative to (a) speech aerodynamic assessment, (b) computer-assisted single-word speech intelligibility testing, and (c) behavioral management of hypernasal resonance are reviewed. Future directions and/or refinement of each area are also identified. It is suggested that both challenging and rewarding times are in store for clinical researchers in craniofacial disorders.

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