Value of peritoneal cytology in potentially resectable pancreatic cancer

Abstract

CY+ status is not clinically equivalent to gross peritoneal metastasis in patients with pancreatic cancer. Curative resection is still recommended regardless of CY status.

Prognostic significance of positive peritoneal cytology in resectable pancreatic cancer: a systemic review and meta-analysis

“…Previously, CY+ was associated with high pre-operative CA19-9 levels [12], larger tumors [12, 13, 15, 20, 25], tumor location in the body/tail of the pancreas [12, 13, 26], lymph node metastasis [12], vascular invasion [11], serosal invasion [15, 16] and late TNM stage [13, 26]. Our results showed that CY+ was more frequent in advanced resectable pancreatic cancer patients and was significantly associated with larger tumor size (OR 11.65, P = 0.001), tumor located in pancreatic head (OR 0.37, P = 0.000), serosal invasion (OR 3.89, P = 0.000), portal vein invasion (OR 1.82, P = 0.016), lymph vessel invasion (OR 2.71, P = 0.026), T stage (OR 2.65, P = 0.037) and N stage (OR 2.34, P = 0.001).…”

“…However, the impact of CY+ on long-term survival of pancreatic cancer was uncertain. Some surgeons from Japan believed that CY+ status in the absence of other distant metastasis was not a contraindication for radical surgery and that surgical resection offered a chance for long-term survival [15, 16, 20, 25]. In contrast, other studies suggested that patients with CY+ experienced peritoneal recurrence and poor survival time inspite of radical surgery and adjuvant chemotherapy [11–14].…”

“…However, the prognostic significance of CY+ in potentially resectable pancreatic cancer is controversial. Some studies from Japan reported that CY+ without distant metastasis should not preclude resection in resectable pancreatic cancer patients and that long-term survival was possible after adjuvant chemotherapy [15, 16, 20]. In contrast, several other studies showed that patients with CY+ status were associated with advanced disease and poor prognosis and had survival rates equivalent to other stage IV diseases [11–14].…”

Pancreatic Cancer With Malignant Ascites

“…Patients with MA diagnosed by peritoneal washing cytology alone in curative intent surgery or those with recurrent pancreatic cancer after curative surgery were excluded. 12 This study was approved by the ethical committee at the University of Tokyo Hospital.…”

S-1 plus nab -paclitaxel is a promising regimen for pancreatic cancer in a preclinical model

“…Most patients with pancreatic cancer are diagnosed at an advanced stage, with a 5‐year survival rate of less than 5% and a median survival of less than 12 months . Unfortunately, even in patients who undergo radical resection and adjuvant chemotherapy, pancreatic cancer frequently relapses, mainly in the liver, peritoneum, lymph nodes, or remnant pancreas, within 2 years after radical surgery . As for the systemic chemotherapy for metastatic or locally advanced pancreatic cancer, gemcitabine monotherapy has long been the standard treatment despite its modest survival benefit .…”