Abstracts
1997 Digestive Disease Week

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

U Ribeiro Jr, JJ Gama-Rodrigues, AV Safatle-Ribeiro, B Bitelman, R Ibrahim, MB Ferreira, AA Laudanna, HW Pinotti. Department of Gastroenterology, University of Sao Paulo, Brazil.

Laparoscopy is a safe and useful method to examine local extent and regional spread of patients with gastric cancer. Peritoneal dissemination is still a frequent type of recurrence after surgical treatment. Aim: To determine the prognostic value of intraperitoneal free cancer cells (IFCC) detected by laparoscopic peritoneal lavage. Methods: Forty-nine patients with potentially resectable gastric cancer were prospectively studied and underwent laparoscopy with cytologic examination for staging. Peritoneal lavage was performed when ascites was not present. Aspirated fluid of the peritoneal cavity was centrifuged and submitted to cytologic examination using Giemsa and Papanicolaou methods. The patients were surgically treated and followed for 54 months. Results: IFCC were detected in 41% of the patients, 65% in patients with ascites and 28% by peritoneal lavage. In the absence of macroscopic peritoneal dissemination, IFCC were found in 29% of the patients. As a result of the peritoneal lavage cytology, 6/17 (35.3%) of the patients were re-classified from stage III to stage IV. In 8 cases (16.3%) laparoscopy revealed carcinomatosis and/or multiple liver metastases, so laparotomy was not performed. Palliative surgery without resection was performed in 10 (20.4%) patients and resections in 31 (63.3%). Of those, 15 (30.6%) underwent palliative gastrectomy and 16 (32.7%) curative gastrectomy. The pattern of recurrence following resection was: peritoneal= 7 (25%), local= 6 (21.4%), liver= 5 (17.9%) and others= 2 (7.1%). IFCC were associated with peritoneal recurrence (7/8 IFCC patients had recurrence, while 23 patients without IFCC did not recur, p=0.00001). The absence of IFCC was associated with improved overall survival (33.22 months - 95% CI= 22.9-43.5, vs. 10.43 - 95% CI= 3.8-17.0, p=0.004). Overall survival adjusted for type of resection also demonstrated a favorable outcome for negative IFCC patients (Curative resection: negative IFCC= 43.19 months vs. positive= 10.5; Palliative: negative IFCC= 14 months vs. 10.4, p=0.01). Conclusions: 1. Laparoscopic peritoneal lavage cytology may be useful in identifying patients at high risk for peritoneal relapses and may alter treatment. 2. IFCC provide additional prognostic information in gastric cancer patients.