Introduction: Evaluation of peritoneal cytology during laparoscopic staging has been shown to provide valuable staging information in patients with gastric and pancreatic adenocarcinoma; however, no data exists regarding its utility in patients with hilar cholangiocarcinoma. The aim of our study was to prospectively evaluate the presence of positive peritoneal cytology in M0 and M1 disease and the influence of positive peritoneal cytology on survival.
Methods: From 10/97 through 3/00, laparoscopic washings were obtained from 25 patients with hilar cholangiocarcinoma. Peritoneal washings were obtained from the right and left upper quadrants before any biopsies were taken. Cytological analysis was performed using the Papanicolau technique.
Results: Eight females and 18 males were identified with a median age of 69 y/o (range 42-81). The most common presenting symptom was jaundice (n=19). Prior stenting was performed in 22 of the patients with 8 undergoing percutaneous and 14 undergoing endoscopic drainage. Metastatic disease was suspected pre-operatively in 6 patients, 3 to the liver, 2 to the peritoneum and 1 to regional lymph nodes. Laparoscopy identified 7 additional patients with unresectable disease. Positive peritoneal cytology was seen in only 2 patients, and both had obvious peritoneal metastases. Seven other patients had metastatic disease to distant sites, but none had positive cytology. Overall, 6 patients were found to have metastatic disease to the peritoneal cavity, none of whom had undergone prior percutaneous drainage. The prevalence of positive cytology by stage was as follows : 0% (0/4) in T2M0 disease; 0% (0/11) in T3M0 disease; and 22% (2/9) in M1 disease.
Conclusions: Peritoneal cytology was not predictive of advanced stage disease, even in the presence of macroscopic disease. Preoperative percutaneous drainage was not predictive of peritoneal disease. Laparoscopic staging identifies some patients with unresectable hilar cholangiocarcinoma but analysis of peritoneal cytology provides no additional information.
