Percutaneous Peritoneal Lavage Research Articles

Abstract 4355: Different strategies for peritoneal lavage cytology testing in the staging of gastric cancer: A cost-effectiveness analysis

Abstract Background & Aims: The positive peritoneal cytology (PCY) indicates metastasis disease in patients with gastric cancer (GC); thus, the cytology testing is directly related to subsequent treatments, patients' prognoses, and medical costs. However, the cost-effectiveness of PCY testing remains unclear. We aim to evaluate the cost-effectiveness of PCY testing by comparing two active testing strategies of a guideline-recommended intraoperative laparoscopic peritoneal lavage (ILPL) and a newly proposed preoperative percutaneous peritoneal lavage (PPPL), and a third strategy of exploratory laparotomy with no cytology testing (ELNC) among GC patients. Methods: We developed a decision-analytic Markov model to compare the cost-effectiveness of the above three strategies for a hypothetical cohort of GC patients with curative intent after initial imaging, from the perspective of Chinese society. Quality-adjusted life-years (QALYs), transition probabilities and costs were modeled using data mainly from published literature. We performed base case analysis and measured incremental cost-effectiveness ratios (ICERs) for various strategies, which were compared to a willingness-to-pay (WTP) threshold that was set to a three-fold of Chinese gross domestic product (GDP) per capita, $29,313/QALY gained. Furthermore, we conducted both one-way and probabilistic sensitivity analyses to investigate the model's robustness. Results: In the base case analysis, we found that ELNC was dominated (i.e., more expensive and less effective) by PPPL and ILPL. ILPL was the most cost-effective method, with an ICER of US $16,673/QALY compared to PPPL. One-way sensitivity analyses demonstrated that the exploratory laparotomy mortality following ILPL and the peritoneal cytology prevalence were the only two influential parameters within their plausible range when assessing the cost-effectiveness of PPPL and ILPL. In the probabilistic sensitivity analyses, the probability of ILPL being cost-effective was 71.3% at the WTP threshold of $29,313/QALY; however, PPPL was more likely to be cost-effective when the willing-to-pay (WTP) threshold was below $17,020/QALY gained. Conclusion: Cytology testing for GC staging through either ILPL or PPPL dominated ELNC in patients with curative intent. Moreover, ILPL was the most cost-effective modality at the current WTP threshold, while PPPL could potentially be cost-effective in lower-income areas. Citation Format: Qifei He, Jinyi Zhu, Anqiang Wang, Xia Li, Zhaode Bu, Jiafu Ji. Different strategies for peritoneal lavage cytology testing in the staging of gastric cancer: A cost-effectiveness analysis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4355.

Percutaneous Peritoneal Lavage for the Rapid Staging of Gastric and Pancreatic Cancer

Percutaneous Peritoneal Lavage for the Rapid Staging of Gastric and Pancreatic Cancer

Diagnostic, percutaneous peritoneal lavage in blunt trauma: Rationale, technique and results: Simpson RL, Turner VF Aust N Z J Surg 56:103–107 Feb 1986

Diagnostic, percutaneous peritoneal lavage in blunt trauma: Rationale, technique and results: Simpson RL, Turner VF Aust N Z J Surg 56:103–107 Feb 1986

Diagnostic, percutaneous peritoneal lavage in blunt abdominal trauma: rationale, technique and results.

The records of 90 consecutive adult patients, who presented after blunt abdominal trauma and who underwent diagnostic, percutaneous peritoneal lavage over a 3 year period, were reviewed. Lavage effluents were considered positive, negative or equivocal. An equivocal result was one where the tubing contained blood stained fluid, but it was still possible to see newsprint through the tubing. Fifty-one lavages were positive, 24 negative and 15 equivocal. All 51 patients with a positive effluent and three of the patients with an equivocal effluent had a laparotomy and in all but one case a significant injury was found. There were no false negative results. In a single patient the transverse colon was perforated during the insertion of the lavage catheter. Diagnostic, percutaneous peritoneal lavage is a simple, safe, rapidly performed, accurate technique designed to detect intraperitoneal blood and the results of this review suggest that it has a role to play in the decision-making process when assessing adult patients who have suffered blunt abdominal trauma.

Acute Pancreatitis—Where Are We?

Clinical management of acute pancreatitis remains controversial. None of the nonsurgical measures that have undergone controlled clinical trials has demonstrated any significant therapeutic benefit. No subgroup of patients who benefit from early intra-abdominal surgery has been identified. Percutaneous peritoneal lavage appears to be an extremely effective adjunct to the management of early cardiovascular and respiratory complications of severe acute pancreatitis and has prevented virtually all early deaths from these causes. Lavage has not prevented the late septic sequelae of peripancreatic necrosis, and better measures are still needed to prevent and treat these complications.

Value of “Inconclusive Lavage” in Abdominal Trauma Management

Peritoneal lavage is an invaluable adjunct in the evaluation of abdominal trauma. Of 780 abdominal trauma patients in a prospective study, 685 underwent percutaneous peritoneal lavage. RBC counts in the effluent above 50,000/mm3 corresponded well with findings at exploration; however, two thirds of the patients having counts between 20,000--50,000/mm3 had serious injury at celiotomy. The data suggest the need for a reappraisal of lavage criteria for operation.