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Annals of Surgical Oncology

, Volume 17, Issue 2, pp 455–460 | Cite as

Positive Peritoneal Washing Cytology in Multiple Cavities Can Predict Poor Prognosis of Advanced Gastric Cancer Patients

  • Yoichiro Homma
  • Shinichiro Ushida
  • Makoto Yamada
  • Hiroshi Kobayashi
  • Kazufumi Suzuki
Gastrointestinal Oncology

Abstract

Background

Positive peritoneal washing cytology (PWC) has been reported to be a poor prognostic factor for gastric cancer. Japanese gastric cancer classifications recommend PWC in Douglas’ pouch for advanced gastric cancer. However, the sensitivity of PWC is relatively low. The goal of this study was to investigate whether PWC in multiple cavities increases its sensitivity to predict prognosis.

Methods

Between January 1996 and December 2006, a series of 992 patients with gastric cancer underwent D2 gastrectomy with intraoperative PWC. Of the 992 patients, 62 patients had positive PWC. PWC was conducted in four cavities (left subphrenic cavity, right subhepatic cavity, Douglas’ pouch, and inside the omental bursa). The 62 patients were retrospectively analyzed for their background and survival.

Results

Eleven (17.7%) patients had negative PWC in Douglas’ pouch but were positive in the other cavities. The 62 patients were classified into two groups according to the number of positive PWC cavities: 20 patients with one or two and 42 patients with three or four positive PWC cavities. No significant difference in clinicopathological features was observed between these two groups. However, the overall and progression-free survival rates of patients with one or two positive PWC cavities were significantly higher than those for patients with three or more positive PWC cavities.

Conclusion

PWC in multiple cavities was more sensitive than only in one cavity. The number of positive cavities may indicate the grade of tumor spread in the peritoneum and predict the prognosis of patients with positive PWC.

Keywords

Gastric Cancer CDDP Advanced Gastric Cancer Peritoneal Metastasis Postoperative Adjuvant Chemotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

The authors thank former codirector of SHGH, Dr. Yuzo Nakaya (Nakaya Clinic), for establishing our surgical procedures, and the codirector of SHGH, Dr. Shigeo Tobayama, for his encouragement during all stages of this study.

References

  1. 1.
    Maruyama K, Kaminishi M, Hayashi K, et al. Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer. 2006;9(2):51–66.CrossRefPubMedGoogle Scholar
  2. 2.
    Kodera Y, Yamamura Y, Shimizu Y, et al. Peritoneal washing cytology: prognostic value of positive findings in patients with gastric carcinoma undergoing a potentially curative resection. J Surg Oncol. 1999;72(2):60−4 (discussion 64–5).CrossRefPubMedGoogle Scholar
  3. 3.
    Japanese Gastric Cancer A. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer. 1998;1(1):10–24.CrossRefGoogle Scholar
  4. 4.
    Cetin B, Atalay C, Aslan S, et al. Peritoneal carcinoembryonic antigen level for predicting locoregional and distant spread of gastric cancer. Surg Today. 2005;35(11):919–24.CrossRefPubMedGoogle Scholar
  5. 5.
    Bando E, Yonemura Y, Takeshita Y, et al. Intraoperative lavage for cytological examination in 1,297 patients with gastric carcinoma. Am J Surg. 1999;178(3):256–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Kodera Y. Disseminated cancer cells in the peritoneal cavity: what can we do when we detect them? Gastric Cancer. 2008;11(4):192–3.CrossRefPubMedGoogle Scholar
  7. 7.
    Li JK, Zheng M, Miao CW, et al. Peritoneal lavage cytology and carcinoembryonic antigen determination in predicting peritoneal metastasis and prognosis of gastric cancer. World J Gastroenterol. 2005;11(46):7374–7.PubMedGoogle Scholar
  8. 8.
    Wu CC, Chen JT, Chang MC, et al. Optimal surgical strategy for potentially curable serosa-involved gastric carcinoma with intraperitoneal free cancer cells. J Am Coll Surg. 1997;184(6):611–7.PubMedGoogle Scholar
  9. 9.
    Suzuki T, Ochiai T, Hayashi H, et al. Peritoneal lavage cytology findings as prognostic factor for gastric cancer. Semin Surg Oncol. 1999;17(2):103–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Bonenkamp JJ, Songun I, Hermans J, van de Velde CJ. Prognostic value of positive cytology findings from abdominal washings in patients with gastric cancer. Br J Surg. 1996;83(5):672–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Fujiwara Y, Doki Y, Taniguchi H, et al. Genetic detection of free cancer cells in the peritoneal cavity of the patient with gastric cancer: present status and future perspectives. Gastric Cancer. 2007;10(4):197–204.CrossRefPubMedGoogle Scholar
  12. 12.
    Singletary SE, Greene FL, Sobin LH. Classification of isolated tumor cells: clarification of the 6th edition of the American Joint Committee on Cancer staging manual. Cancer. 2003;98(12):2740–1.CrossRefPubMedGoogle Scholar
  13. 13.
    Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357(18):1810–20.CrossRefPubMedGoogle Scholar
  14. 14.
    Moriguchi S, Maehara Y, Korenaga D, et al. Risk factors which predict pattern of recurrence after curative surgery for patients with advanced gastric cancer. Surg Oncol. 1992;1(5):341–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Kodera Y, Nakanishi H, Ito S, et al. Prognostic significance of intraperitoneal cancer cells in gastric carcinoma: detection of cytokeratin 20 mRNA in peritoneal washes, in addition to detection of carcinoembryonic antigen. Gastric Cancer. 2005;8(3):142–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Euanorasetr C, Lertsithichai P. Prognostic significance of peritoneal washing cytology in Thai patients with gastric adenocarcinoma undergoing curative D2 gastrectomy. Gastric Cancer. 2007;10(1):18–23.CrossRefPubMedGoogle Scholar
  17. 17.
    Bonenkamp JJ, Sasako M, Hermans J, van de Velde CJ. Tumor load and surgical palliation in gastric cancer. Hepatogastroenterology. 2001;48(41):1219–21.PubMedGoogle Scholar
  18. 18.
    Hartgrink HH, Putter H, Klein Kranenbarg E, et al. Value of palliative resection in gastric cancer. Br J Surg. 2002;89(11):1438–43.CrossRefPubMedGoogle Scholar
  19. 19.
    Maeta M, Sugesawa A, Ikeguchi M, et al. Does the extent of lymph node dissection affect the postoperative survival of patients with gastric cancer and disseminating peritoneal metastasis? Surg Today. 1994;24(1):40–3.CrossRefPubMedGoogle Scholar
  20. 20.
    Boku N. Chemotherapy for metastatic disease: review from JCOG trials. Int J Clin Oncol. 2008;13(3):196–200.CrossRefPubMedGoogle Scholar
  21. 21.
    Koizumi W, Narahara H, Hara T, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008;9(3):215–21.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Yoichiro Homma
    • 1
  • Shinichiro Ushida
    • 1
  • Makoto Yamada
    • 2
  • Hiroshi Kobayashi
    • 2
  • Kazufumi Suzuki
    • 1
  1. 1.Department of Gastrointestinal SurgerySeirei Hamamatsu General HospitalShizuokaJapan
  2. 2.Department of PathologySeirei Hamamatsu General HospitalShizuokaJapan

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