A single-institution retrospective analysis of gastric carcinoma with positive peritoneal lavage cytology and without serosal invasion: A case series.

Taizo Sakata,Toshikazu Kimura,Takaomi Takahata,Yoshihiro Akazai,Tetsushige Mimura,Alan Kawarai Lefor,Isao Yasuhara,Toru Kojima

doi:10.1016/j.amsu.2019.01.003

Taizo Sakata, Toshikazu Kimura + Show 6 more

Open Access

https://doi.org/10.1016/j.amsu.2019.01.003

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Abstract

Background and objectivesPeritoneal dissemination of gastric cancer is often associated with serosal infiltration. The aim of this study was to evaluate the clinical importance of peritoneal lavage cytology in patients with gastric carcinoma without serosal invasion. The incidence and impact on prognosis of positive cytology were analyzed.MethodsOf 2768 patients with gastric cancer, outcomes and pathological characteristics of 973 patients were reviewed retrospectively. All patients underwent peritoneal lavage at laparotomy for curative or palliative resection of gastric cancer between 1999 and 2017. Among these, 479 who underwent surgery from January 1999 to March 2012 were also reviewed to analyze 5-year survival.ResultsOf 973 patients enrolled, 338 (35%) did not have serosal invasion, and peritoneal cytology was positive in 4/338 (1.2%). Of these four patients, one had submucosal invasion and three had muscularis propria invasion. Of 635 patients with serosal invasion, peritoneal cytology was positive in 74/635 (12%). Of 479 patients reviewed for survival, cytology was positive in 32/479, with 3/32 (9%) surviving for five years, and cytology was negative in 447 patients with 266/447 (60%) surviving for five years.ConclusionsCytologic evaluation should be routinely performed in patients with early-stage gastric cancer.

Highlights

Advances in diagnostic methods and treatment have contributed to decreasing overall mortality from many malignancies, the prognosis of patients with gastric carcinoma is often poor due to a high incidence of peritoneal metastases, which is the most frequent site of recurrence [1]
We report one patient with gastric cancer invading the submucosa and three with muscularis propria invasion who presented with positive peritoneal cytology
In order to highlight the clinicopathologic characteristics of the four patients without serosal invasion by tumor, but with positive peritoneal cytology, we review each of them here briefly

Summary

Introduction

Advances in diagnostic methods and treatment have contributed to decreasing overall mortality from many malignancies, the prognosis of patients with gastric carcinoma is often poor due to a high incidence of peritoneal metastases, which is the most frequent site of recurrence [1]. In 1998, the Japanese Classification of Gastric Carcinoma published the second English edition based on the 13th Japanese edition that includes the results of cytologic evaluation of peritoneal lavage fluid in the TNM staging system. This identifies patients with positive peritoneal cytology (CY1) as having Stage IV disease. The aim of this study was to evaluate the clinical importance of peritoneal lavage cytology in patients with gastric carcinoma without serosal invasion. Results: Of 973 patients enrolled, 338 (35%) did not have serosal invasion, and peritoneal cytology was positive in 4/338 (1.2%). Conclusions: Cytologic evaluation should be routinely performed in patients with early-stage gastric cancer

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Discussion

Conclusion