Detection of Intra-peritoneal Free Cancer Cell during Laparoscopic Staging of Patients with Advanced Gastric Carcinoma / 대한소화기내시경학회지

ABSTRACT

BACKGROUND/AIMS: Peritoneal dissemination is the most frequent type of recurrence in gastric cancer after curative surgery. Such recurrences may be attributable to possible intra-peritoneal dissemination of malignant cells. The aim of this study was to investigate the role of diagnostic laparoscopy and peritoneal lavage cytology to detect intra-peritoneal dissemination pre-operatively in the staging of advanced gastric cancer. METHODS: Laparoscopy and peritoneal lavage was performed in patients with advanced gastric adenocarcinoma after noninvasive staging had shown no irresectable locoregional disease and/or distant metastases. The peritoneal cavity was washed and allowed to collect during laparoscopic examination and stained by Papanicolaou methods. The results were compared with TNM stage, size of cancer, endoscopic diagnosis, and histologic type. RESULTS: Thirty-three patients were included. Peritoneal metastasis and intra-peritoneal free cancer cells were proven histo/ cytologically in seven patients (21.2%) and cytologically only in three patients (9.1%). All of these patients were stage IIIB or stage IV and showed higher stages than cytologically negative patients (p<0.01). CONCLUSIONS: Laparoscopic staging in advanced gastric cancer patients may be a good diagnostic method to detect intra-peritoneal dissemination. Detection of intra-peritoneal free cancer cells may suggest more advanced stage of gastric cancer. Peritoneal lavage cytology may be used to predict a serosal or direct invasion to adjacent organs.