Skip to main content

Advertisement

SpringerLink
Log in

Does Neoadjuvant Treatment for Gastric Cancer Patients with Positive Peritoneal Cytology at Staging Laparoscopy Improve Survival?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The purpose of this study was to identify clinicopathologic factors associated with positive peritoneal cytology (PPC) in patients with gastric cancer and to compare the overall survival (OS) of patients with PPC treated with and without neoadjuvant therapy.

Methods

The medical records of 3,747 patients with gastric or gastroesophageal adenocarcinoma presenting to our institution (January 1995 to December 2005) were reviewed to identify those patients who underwent diagnostic laparoscopy as a staging procedure prior to consideration for neoadjuvant therapy. Associations between various clinicopathologic factors and OS were examined with Cox proportional hazards models. Kaplan–Meier curves were created to compare OS between groups.

Results

Of 381 patients who underwent diagnostic laparoscopy for staging, 39 were found to have PPC without gross metastatic disease. Linitis plastica and tumors located at the gastroesophageal junction were identified as predictors of PPC (P < 0.01). Median follow-up for living patients was 51 months. Median OS for patients with PPC and no gross metastatic disease at laparoscopy (13 months) was no different from that for patients with gross metastatic disease at laparoscopy (10 months, P = 0.06). For the 39 patients with PPC and no gross metastatic disease, use of neoadjuvant therapy resulted in a 3-year OS rate of 12% versus 0% for patients who did not receive neoadjuvant therapy.

Conclusion

Outcomes for patients with PPC without gross metastatic disease are not significantly different from those patients with gross metastatic disease at laparoscopy. However, some patients can achieve long-term survival and should be considered for neoadjuvant treatment prior to attempts at surgical resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. The Gastric Cancer Clinical Practice Guidelines in Oncology (Version 2.2007). ©2007 National Comprehensive Cancer Network, Inc. Available at: http://www.nccn.org. Accessed [2/29/08]

  2. D’Angelica M, Gonen M, Brennan MF, et al. Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg 2004;240:808–16

    Article  PubMed  Google Scholar 

  3. Maehara Y, Kakeji Y, Oda S, et al. Tumor growth patterns and biological characteristics of early gastric carcinoma. Oncology2001;61:102–12

    Article  PubMed  CAS  Google Scholar 

  4. Bentrem D, Wilton A, Mazumdar M, et al. The value of peritoneal cytology as a preoperative predictor in patients with gastric carcinoma undergoing a curative resection. Ann Surg Oncol2005;12:347–53

    Article  PubMed  Google Scholar 

  5. Ribeiro U Jr, Gama-Rodrigues JJ, Bitelman B, et al. Value of peritoneal lavage cytology during laparoscopic staging of patients with gastric carcinoma. Surg Laparosc Endosc1998;8:132–5

    Article  PubMed  Google Scholar 

  6. Ribeiro U Jr, Gama-Rodrigues JJ, Safatle-Ribeiro AV, et al. Prognostic significance of intraperitoneal free cancer cells obtained by laparoscopic peritoneal lavage in patients with gastric cancer. J Gastrointest Surg1998;2:244–9

    Article  PubMed  Google Scholar 

  7. Abe S, Yoshimura H, Tabara H, et al. Curative resection of gastric cancer: limitation of peritoneal lavage cytology in predicting the outcome. J Surg Oncol1995;59:226–9

    Article  PubMed  CAS  Google Scholar 

  8. Yoshikawa T, Tsuburaya A, Kobayashi O, et al. Peritoneal cytology in patients with gastric cancer exposed to the serosa–a proposed new classification based on the local and distant cytology. Hepatogastroenterology2003;50:1183–6

    PubMed  Google Scholar 

  9. Bonenkamp JJ, Songun I, Hermans J, et al. Prognostic value of positive cytology findings from abdominal washings in patients with gastric cancer. Br J Surg1996;83:672–4

    Article  PubMed  CAS  Google Scholar 

  10. Burke EC, Karpeh MS Jr., Conlon KC, et al. Peritoneal lavage cytology in gastric cancer: an independent predictor of outcome. Ann Surg Oncol1998;5:411–5

    Article  PubMed  CAS  Google Scholar 

  11. Bando E, Yonemura Y, Takeshita Y, et al. Intraoperative lavage for cytological examination in 1,297 patients with gastric carcinoma. Am J Surg 1999;178:256–62

    Article  PubMed  CAS  Google Scholar 

  12. Suzuki T, Ochiai T, Hayashi H, et al. Peritoneal lavage cytology findings as prognostic factor for gastric cancer. Semin Surg Oncol1999;17:103–7

    Article  PubMed  CAS  Google Scholar 

  13. Japanese Gastric Cancer A. Japanese Classification of Gastric Carcinoma-2nd English Edition. Gastric Cancer1998;1:10–24

    Article  Google Scholar 

  14. Greene FL, Page DL, Fleming ID, et al. AJCC Cancer Staging Manual, 6th edition. New York: Spring-Verlag, 2002

  15. Fienberg S. The Analysis of Cross-Classified Categorical Data, 2nd edition. Cambridge: The MIT Press, 1983

  16. Conover W. Practical Nonparametric Statistics, 2nd edition. New York: Wiley, 1980

  17. Link C. Confidence intervals for the survival function using Cox’s proportional hazards model with covariates. Biometrics1984;40:601–10

    Article  PubMed  CAS  Google Scholar 

  18. Hosmer DW, Lemeshow S. Applied Survival Analysis, 1st edition. New York: Wiley, 1999

  19. Fleming TH, Harrington DP. Nonparametric estimation of the survival distribution in censored data. Commun Stat1984; 4:2469–86

    Article  Google Scholar 

  20. Kalbfleisch JD, Prentice RL. The Statistical Analysis of Failure Time Data. New York: Wiley, 1980

  21. Nakagawa S, Nashimoto A, Yabusaki H. Role of staging laparoscopy with peritoneal lavage cytology in the treatment of locally advanced gastric cancer. Gastric Cancer2007;10:29–34

    Article  PubMed  CAS  Google Scholar 

  22. Yan TD, Black D, Sugarbaker PH, et al. A systematic review and meta-analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for resectable gastric cancer. Ann Surg Oncol2007;14:2702–13

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

We would like to acknowledge Kristi M. Speights for editorial assistance.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Unit 444, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, P.O. Box 301402, Houston, TX, 77030, USA

    Brian Badgwell MD, Janice N. Cormier MD, MPH, Peter W. T. Pisters MD, Barry Feig MD & Paul Mansfield MD

  2. Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Sunil Krishnan MD

  3. Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    James Yao MD

  4. Department of Pathology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Gregg A. Staerkel MD

  5. Department of Epidemiology, The University of Texas School of Public Health, Houston, TX, 77030, USA

    Philip J. Lupo MPH

Authors
  1. Brian Badgwell MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janice N. Cormier MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sunil Krishnan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Yao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gregg A. Staerkel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philip J. Lupo MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter W. T. Pisters MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Barry Feig MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Paul Mansfield MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Mansfield MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Badgwell, B., Cormier, J.N., Krishnan, S. et al. Does Neoadjuvant Treatment for Gastric Cancer Patients with Positive Peritoneal Cytology at Staging Laparoscopy Improve Survival?. Ann Surg Oncol 15, 2684–2691 (2008). https://doi.org/10.1245/s10434-008-0055-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-008-0055-3

Keywords

Search

Navigation