An alternative method to detect peritoneal recurrence of gastric cancer: Clinical application of CT colonography.

19 Background: Peritoneal metastasis (PM) is among the most frequent patterns of recurrence of gastric cancer: however, it cannot be detected by general axial CT or even by PET until it develops to massive ascites or an overt peritoneal mass. CT colonography (CTC) is used to screen for colon cancer, with the advantage that it can provide both colonic and extracolonic information at the same time. Methods: CTC was applied for patients that were suspected to have PM based on their clinical symptoms and general CT findings, without sufficient information to confirm the diagnosis, to detect signs of peritoneal metastasis earlier. PM diagnosis in CTC was defined as the finding of an abnormal deformity of the colonic wall without intraluminal tumor by both the attending doctors and radiologists. Results: Twelve patients suspected of having PM were enrolled in the study. Nine of those patients (75%) were positive for PM by CTC. Abnormal colonic deformities were also identified in other locations other than the lesions detected by general CT in 6 patients. All of the nine patients with positive PM were clinically confirmed to have PM, and had a poorer prognosis (median survival: 252 days). The three patients with negative PM are all alive without recurrence. Conclusions: CTC is thus considered to be a candidate for the early detection of PM. Further study with more patients is therefore warranted.