Prognostic significance of intraperitoneal free cancer cells obtained by laparoscopic peritoneal lavage in patients with gastric cancer.

Laparoscopy is a safe and useful method for examining the local extent and regional spread of disease in patients with gastric cancer. Peritoneal dissemination remains a frequent type of recurrence after surgical treatment. The aim of this study was to determine the prognostic value of intraperitoneal free cancer cells (IFCCs) detected by laparoscopic peritoneal lavage. Forty-nine patients with advanced gastric cancer underwent laparoscopy with cytologic examination for staging. Peritoneal lavage was performed when ascites was not present. Aspirated fluid from the peritoneal cavity was centrifuged and subjected to cytologic examination using Giemsa and Papanicolaou staining methods. Patients were surgically treated and followed for a minimum of 5 years. IFCCs were detected in 41% of the patients. In eight cases (16.3%) laparoscopy revealed carcinomatosis and/or multiple liver metastases, so laparotomy was not performed. Patterns of recurrence after curative resection included the following: peritoneal (n = 3), local (n = 4), liver (n = 1), and other (n = 1). All patients who tested positive for IFCCs had peritoneal recurrence. The absence of IFCCs was associated with improved overall survival (21 months for a 95% confidence interval of 7.4 to 34.6 vs. 4 months for a 95% confidence interval of 2.4 to 5.6). Overall survival adjusted for type of resection also demonstrated a favorable outcome for patients who were negative for IFCCs. The following conclusions were drawn: (1) laparoscopic peritoneal lavage cytology may be useful in identifying patients at high risk for peritoneal relapses and may alter treatment, and (2) lFCCs provide additional prognostic information in patients with gastric cancer.

Value of peritoneal lavage cytology during laparoscopic staging of patients with gastric carcinoma.

Forty-nine consecutive patients with advanced gastric carcinoma underwent preoperative staging by laparoscopy between June 1991 and June 1992. Peritoneal lavage with cytologic examination was performed when ascites was not present. In eight cases (16.3%), laparoscopy revealed carcinomatosis and/or multiple hepatic metastases, so laparotomy was not performed. Intraperitoneal free cancer cells (IFCCs) were detected in 41% of patients (65% in patients with ascites and 28% by peritoneal lavage). In the absence of macroscopic peritoneal dissemination, IFCCs were encountered in 29% of patients. IFCCs were present only when invasion of the gastric serosa was >3 cm2 or when adjacent organs and structures were already invaded. Mucinous adenocarcinoma, Borrmann class IV tumors, and Stage IV patients had higher incidence of IFCCs. Cytologic results were similar at laparoscopy and laparotomy (p > 0.05). Therefore, cytologic evaluation of peritoneal lavage added sensitivity to laparoscopy in assessing patients with advanced gastric carcinoma and may alter their therapeutic approach.

[The laparoscopy method in preoperative evaluation of patients with malignant stomach neoplasm]. / O método laparoscópico na avaliação pré-operatória de pacientes com neoplasia maligna do estômago.

In 190 patients with malignant gastric neoplasia the value of laparoscopy for diagnosing intra-abdominal metastases was investigated. At the laparoscopic examination the presence of tumoral tissue was appraised on the serosal coat of the stomach, epiploons, parietal and visceral peritoneum, and in the liver. On hand of laparoscopic findings (peritoneal or hepatic metastases) the surgical treatment was discarded in 34 patients (70.6%). In the remaining 29.4% of patients a bad general condition or concomitant diseases contra-indicated surgical intervention. A comparison of laparoscopic and surgical findings showed that correct diagnosis was established by laparoscopy in 61.4% of cases with tumoral invasion of gastric serosa, in 21.4% of cases with involvement of epiploon, in 27% of parietal peritoneum, and in 33.3% of the liver. Falsely positive findings were rare (5% of examinations).

Laparoscopy in children and for screening: a new technique.

Uma nova tecnica de laparoscopia em criancas e para exploracao rapida e descrita. O instrumento e o laparoscopico infantil de 4mm da firma Storz usado com uma canula trocarte especial. A vantagem do metodo e de requerer somente uma puncao da cavidade peritonial, sendo o instrumento optico introduzido atraves da canula de pneumoperitonio

Peritonite tuberculosa.Estudo de 100 casos. / Tuberculous peritonitis. Study of 100 cases

Cem casos de peritonite tuberculosa foram estudados. Sessenta e sete doentes pertenciam ao sexo feminino e 33 ao masculino; as idades variavam de quatro a 73 anos. Entre as manifestacoes clinicas, as mais importantes eram ascite e febre. O liquido ascitico apresentava aspecto sero-fibrinoso na grande maioria dos casos; menos frequentemente ele era seroso, hemorragico ou leitoso; em comparacao com os derrames por hipertensao portal, os valores de proteinas totais, colesterol, mucoproteina e deidrogenase latica no liquido ascitico eram bem mais altos, enquanto os de glicose eram, em media, mais baixos. Em 29 doentes foi realizada a pesquisa de microbacterias no liquido ascitico pela cultura em meio liquido de Dubos, obtendo-se resultados positivos em 21 deles. Dosagens de proteinas totais e fracoes no soro mostraram, na grande maioria dos casos, aumento de globulinas e diminuicao de albumina. Em todos os doentes, o diagnostico de peritonite tuberculosa foi confirmado pela biopsia peritonial realizada, na maioria das vezes, em conjunto com a laparoscopia