Value of peritoneal cytology in potentially resectable pancreatic cancer
Article first published online: 14 NOV 2013
© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd
British Journal of Surgery
Volume 100, Issue 13, pages 1791–1796, December 2013
How to Cite
Yamada, S., Fujii, T., Kanda, M., Sugimoto, H., Nomoto, S., Takeda, S., Nakao, A. and Kodera, Y. (2013), Value of peritoneal cytology in potentially resectable pancreatic cancer. Br J Surg, 100: 1791–1796. doi: 10.1002/bjs.9307
- Issue published online: 14 NOV 2013
- Article first published online: 14 NOV 2013
- Manuscript Accepted: 2 AUG 2013
Peritoneal lavage cytology (CY) is used in the diagnosis and staging of various cancers. The clinical significance of positive cytology results in patients with pancreatic cancer is yet to be determined.
Peritoneal washing samples were collected from consecutive patients with pancreatic cancer between July 1991 and December 2012. The correlations between cytology results, clinicopathological parameters and recurrence patterns were evaluated. The prognostic impact of CY status, regarding resectability and the effectiveness of adjuvant chemotherapy, were analysed.
Of 523 included patients, 390 underwent resection. Patients with tumours at least 2 cm in diameter were more likely to have CY+ status than patients with tumours smaller than 2 cm (48 of 312 versus 3 of 78 respectively; P = 0·005) and there was a significant correlation between CY+ status and tumour invasion of the anterior pancreatic capsule (43 of 276 versus 8 of 113 with no invasion of the capsule; P = 0·030). Although the overall survival of patients with resected CY+ tumours was worse than that of patients with resected CY− tumours, it was significantly better than the survival of unresected patients regardless of CY status. Multivariable analysis of all patients who had pancreatectomy did not identify CY+ as an independent prognostic factor. Patients with CY+ tumours tended to develop peritoneal metastasis more often than those with CY− tumours, although not significantly so. The median survival time of 34 patients with resected CY+ tumours who received adjuvant chemotherapy was better than that of 17 patients who had surgery alone, although this was not statistically significant (15·3 versus 10·0 months; P = 0·057).
CY+ status is not clinically equivalent to gross peritoneal metastasis in patients with pancreatic cancer. Curative resection is still recommended regardless of CY status.
Presented to the 98th Annual Clinical Congress of the American College of Surgeons, Chicago, Illinois, USA, October 2012