Prognostic significance of intraperitoneal free cancer cells in gastric cancer patients

Abstract

We performed intraoperative peritoneal cytology in 171 gastric cancer patients undergoing curative surgery. Intraperitoneal free cancer cells were demonstrated in almost all patients in whom the area of serosal cancer invasion exceeded 15-20 cm2. In patients with both serosal cancer invasion and free cancer cells the 5-year survival rat was 13% as compared with 85% for patients who had neither, and 40% for patients who had serosal invasion but no free peritoneal cancer cells. Peritoneal metastasis was the most frequently observed recurrence pattern. Therefore, in gastric cancer patients with marked serosal invasion, intraoperative IP administration of cytocidal anticancer drugs should be considered.

A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP)

“…A major problem after surgery for serosa-invasive gastric carcinoma is early postoperative peritoneal metastasis, which is encountered in more than 60% of patients [1]. Despite the recent advances in surgical procedures and adjuvant chemotherapies, no satisfactory outcomes are available, because of residual micrometastases or free-floating carcinoma cells already existing in the peritoneal cavity.…”

Genetic detection of free cancer cells in the peritoneal cavity of the patient with gastric cancer: present status and future perspectives

“…At present, cytological examination of peritoneal lavage fl uid collected at laparotomy is performed to predict peritoneal spread [3][4][5], and this procedure has been incorporated in the Japanese staging system for gastric cancer [6]. The majority of patients with positive cytology on peritoneal lavage develop peritoneal metastasis, although the latter also occurs in patients with negative cytological results [3][4][5].…”

“…The majority of patients with positive cytology on peritoneal lavage develop peritoneal metastasis, although the latter also occurs in patients with negative cytological results [3][4][5]. These results indicate that the conventional cytological examination lacks sensitivity for the detection of residual cancer cells and prediction of peritoneal spread.…”

The detection of gastric cancer cells in intraoperative peritoneal lavage using the reverse transcription–loop-mediated isothermal amplification method

“…The prognosis of patients with advanced gastric cancer invading the gastric serosa is very poor even after curative resection, mainly because of the high incidence of peritoneal recurrence 3) . Recurrence with this pattern is most likely caused by the presence of free cancer cells in the abdominal cavity exfoliated from the serosal surfaces of the primary gastric tumor 4) . Therefore, detection of such micrometastatic cells in the peritoneal cavity is likely to be a useful tool in the selection of intra/post-operative chemotherapy as well as for predicting the outcome of such therapy in these cases 5) .…”