Peritoneal Lavage Cytology Following Neoadjuvant Chemotherapy for Gastric Adenocarcinoma: Low Yield in Detecting Peritoneal Metastases
| Autor: | Ahmed Dehal, Victoria V O'Connor, Ryan Ou, L. Andrew DiFronzo, Stephanie Young |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Chemotherapy business.industry medicine.medical_treatment General Medicine Routine practice Adenocarcinoma Prognosis Gastroenterology Neoadjuvant Therapy Gastric adenocarcinoma Stomach Neoplasms Internal medicine Cytology medicine Advanced disease Humans Laparoscopy Peritoneal Lavage business Peritoneal Neoplasms Neoplasm Staging Retrospective Studies |
| Zdroj: | The American surgeon. 88(6) |
| ISSN: | 1555-9823 2012-2020 |
| Popis: | Background Peritoneal lavage cytology (PLC) can detect advanced disease in gastric adenocarcinoma (GC); however, routine practice remains controversial. Furthermore, the effect of neoadjuvant chemotherapy (NAC) on cytological detection of carcinomatosis is unknown. Methods Using a 2012-2020 prospective database, we retrospectively reviewed patients with GC who underwent NAC followed by a staging laparoscopic peritoneal lavage with or without biopsy of suspicious peritoneal nodules. PLC results were considered discordant if they did not align with the peritoneal biopsy results. Patients with benign peritoneal cytology (Cyt-) or biopsy results who had postoperative time to carcinomatosis of Results Fifty-five patients with GC who underwent NAC followed by staging diagnostic laparoscopy with peritoneal lavage were identified. The majority of the patients in the cohort had Cyt- lavage (89.1%). Of the patients who underwent resection, 76.1% had T3 or greater disease on final pathology and 66% had nodal metastases. In 23 patients (41.8%) who had both peritoneal lavage and biopsy, four cases (17.4%) had discordant results. Diagnostic failure rate was 20% at 6 months and 42.2% at 12 months. The median time to carcinomatosis in patients who were Cyt- or biopsy negative was 7.9 months. Conclusion PLC after NAC has a high diagnostic failure rate and inaccurately predicts carcinomatosis in 20% of patients with GC. Novel methods for identifying cytology positive GC after NAC should also be developed and evaluated, since the risk of peritoneal dissemination is high. |
| Databáze: | OpenAIRE |
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