Laparoscopic Peritoneal Cytology: Can it Affect Decision-Making for Neoadjuvant Treatment of Gastric Cancer?

Abstract

Laparoscopic staging with peritoneal cytology influencing treatment decision-making for tailoring an appropriate therapeutic strategy may improve patients’ oncological outcomes. 1,2 Current imaging technology, including abdominal computer tomography (CT) and positron emission tomography (PET), is unable to detect minimal peritoneal cancer cell dissemination. Accurate pretreatment prediction of peritoneal disease may drive decisions for avoiding neoadjuvant treatment or gastrectomy with extensive D2 lymphadenectomy. In the October issue of the Journal, Badgwell and colleagues 3 report on peritoneal cytology status at diagnostic laparoscopy for staging prior to neoadjuvant treatment and its utility to predict survival of patients with gastric or gastroesophageal adenocarcinomas. Among 381 patients who underwent diagnostic laparoscopy for staging, 39 were found to have positive peritoneal cytology (PPC) without gross metastatic disease after median follow-up of 51 months. There was no significant difference in overall survival between patients with PPC and no gross metastatic disease at laparoscopy and patients with gross metastatic disease at laparoscopy. The authors of that study conclude that, despite the absence of significant difference between the two groups, neoadjuvant treatment followed by surgical resection should be considered for patients with PPC because some patients can achieve long-term survival. Indeed, if there is survival benefit for patients with PPC at laparoscopic staging, neoadjuvant treatment should be offered, but there are several questions and limitations. This is a retrospective study with a small number of patients with PPC (n = 39) and without a protocol for decision-making about which patients will receive neoadjuvant treatment. Tailoring the correct adjuvant treatment to individual patients will revolutionize treatment of cancer patients, but it still remains a dream. 4 Robust markers for selecting the most appropriate neoadjuvant or postoperative adjuvant