No abstract available.
Peritoneal Lavage*

No abstract available.
Peritoneal Lavage*

The usefulness of peritoneal lavage in the identification of patients who require laparotomy after close abdominal trauma is not controversial. Peritoneal lavage should be seen as an adjunct to clinical presentation poses unusual difficulty, for example, when consciousness in impaired or when diagnostic doubt exists... The diagnostic accuracy of peritoneal lavage in blunt abdominal trauma has been shown of 100%. In this collected of 17 patients, the false positive rate was 0%.
Peritoneal Lavage ; Abdominal Injuries ; diagnosis

OBJECTIVETo investigate the relationship of positive rate of peritoneal exfoliated gastric cancer cells with the volume of peritoneal lavage fluid.

METHODSExfoliative cytology of peritoneal lavage was performed at the time of laparotomy for 185 patients with gastric cancer from June 2012 to March 2014 in our department, and the clinicopathological data were analyzed retrospectively. According to the volume of saline irrigation, patients were divided into 200 ml group (40 cases), 500 ml group (45 cases) and 1000 ml group (100 cases). The positive rates of peritoneal exfoliated cells among three groups were compared, and then the associated clinicopathological factors were further analyzed in the highest group.

RESULTSThe positive rates of exfoliated cancer cells were 5%(2/40),11%(5/45) and 19%(19/100) in the 200 ml group, 500 ml group and 1000 ml group respectively. The positive rate of exfoliated cancer cells was highest in the 1000 ml group, and was significantly different as compared to the 200 ml group(P=0.036), but not significantly different as compared to the 500 ml group (P>0.05). Multivariate Logistic regression analysis of 1000 ml group showed that age less than sixty years(OR=12.31, 95% CI:2.05-74.11, P=0.006), circumferential infiltration(OR=0.09, 95% CI:0.01-0.84, P=0.034) and T4 (OR=0.09, 95% CI:0.01-0.56, P=0.010) were independent risk factors for positive rate of exfoliated cancer cells.

CONCLUSIONSGreater volume of saline irrigation can improve the positive rate of peritoneal exfoliated cells in gastric cancer especially for patients with younger age, circumferential infiltration and serosal invasion. The recommended volume should not be less than 1000 ml.

BACKGROUND/AIMS: Peritoneal dissemination is the most frequent type of recurrence in gastric cancer after curative surgery. Such recurrences may be attributable to possible intra-peritoneal dissemination of malignant cells. The aim of this study was to investigate the role of diagnostic laparoscopy and peritoneal lavage cytology to detect intra-peritoneal dissemination pre-operatively in the staging of advanced gastric cancer. METHODS: Laparoscopy and peritoneal lavage was performed in patients with advanced gastric adenocarcinoma after noninvasive staging had shown no irresectable locoregional disease and/or distant metastases. The peritoneal cavity was washed and allowed to collect during laparoscopic examination and stained by Papanicolaou methods. The results were compared with TNM stage, size of cancer, endoscopic diagnosis, and histologic type. RESULTS: Thirty-three patients were included. Peritoneal metastasis and intra-peritoneal free cancer cells were proven histo/ cytologically in seven patients (21.2%) and cytologically only in three patients (9.1%). All of these patients were stage IIIB or stage IV and showed higher stages than cytologically negative patients (p<0.01). CONCLUSIONS: Laparoscopic staging in advanced gastric cancer patients may be a good diagnostic method to detect intra-peritoneal dissemination. Detection of intra-peritoneal free cancer cells may suggest more advanced stage of gastric cancer. Peritoneal lavage cytology may be used to predict a serosal or direct invasion to adjacent organs.
Adenocarcinoma ; Diagnosis ; Humans ; Laparoscopy ; Neoplasm Metastasis ; Peritoneal Cavity ; Peritoneal Lavage ; Recurrence ; Stomach Neoplasms

Gastric cancer with positive peritoneal cytology is a hotspot in the study of gastric cancer, and its prognosis is poor. Intraperitoneal free cancer cells may be associated with cancer cells migration, invasion and metastasis. Tumor T stage, peritoneal metastasis, lymph node metastasis, low histological differentiation, linitis plastica, adenocarcinoma of esophagogastric junction, and operation are the clinicopathological risk factors of gastric cancer with positive peritoneal cytology. Currently, the acquisition of free cancer cells is mainly through diagnostic laparoscopy combined with peritoneal lavage, and cytopathological examination is gold standard for diagnosis. Its treatment strategies are not in consensus, including preoperative chemotherapy combined with radical resection, postoperative chemotherapy and peritoneal local treatment, which can prolong the survival of patients. At present, postoperative chemotherapy is often used in China, and the best treatment strategies remain to be further studied.
China ; Gastrectomy ; Humans ; Neoplasm Staging ; Peritoneal Lavage ; Peritoneal Neoplasms/diagnosis* ; Prognosis ; Retrospective Studies ; Stomach Neoplasms/surgery*

PURPOSE: Peritoneal irrigation and drain insertion were traditionally performed following major abdominal surgery, as routine procedures The aim of this retrospective study was to evaluate the usefulness of peritoneal irrigation and drain insertion following elective gastric cancer surgery. METHODS: Between December 2000 and Feburary 2002, 184 patients having undergone surgery for gastric cancer were divided into two groups, a comparative group (86 patients with peritoneal irrigation and drainage) and an experimental group (98 patient without peritoneal irrigation and drainage). The demographics, histopathological classification, range of dissection, comorbid disease, first passage of flatus, start of soft diet, operation time, anesthesia time and operative complication were analyzed retrospectively in consecutive patients. The data were analyzed by student's t-tests with the level of significance set at P<0.05. RESULTS: No significance differences were found between the two groups in regard to demographics, range of dissection, comorbid disease or complications. However the mean length of hospitalization, operation time and anesthesia time and the first passage of flatus, and start of soft diet in the experimental group were significantly shorter than those in the comparative group. CONCLUSION: The result shows that routine peritoneal irrigation and drain insertion following elective gastric cancer surgery are ineffective in reducing postoperative complications. We think these procedures are unnecessary and offer no considerable advantages.
Anesthesia ; Classification ; Demography ; Diet ; Drainage* ; Flatulence ; Hospitalization ; Humans ; Peritoneal Lavage* ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms*

Peritoneal lavage cytology was performed at the time of gastrectomy for 295 patients with gastric cancer from September 1991 to January 1996 in the Department of Medical Sciences,Chonbuk National University Graduate School. The results were as follows;1) Positive intraperitoneal free cancer cells were observed in 9.8% of all case. And,the higher the S-category, the higher the increase in positive intraperitoneal free cancer cells, but the lower the rate of survival. 2) The higher the spatial extent of the invasion of the gastric serosa,the higher the increase in the positive intraperitoneal free cancer cells. However, There was no statiscal relation between the areas of gastric serosa invasion and the 3-year survival rate. But, especially when the areas of serosa invasion are 5-10cm2, the 3-year survival rate was statiscally higher in the negative intraperitoneal free cancer cell group than in the positive free cancer cell group.(P<0.012). 3) The rate of positive intraperitoneal free cancer cells become higher progressively with increasing the peritoneal invasion, but, there were no 3-year survival patients who have positive peritoneal invasion . In patients with no evidence of peritoneal spread, negative intraperitoneal free cancer cell group had a statistically signigficant higher 3-year survival rate than the positive group.(P<0.0004). 4) For histopathological types of tumors, the incidence of positive intraperitoneal free cancer cells was higher in undifferentiated adenocarcinomas than in differentiated types, though the difference was statistically insignificant. For signet-ring cell carcinomas, the 3-year survival rate of the negative intraperitoneal free cancer cell group was statistically higher than that of the positive group.(P<0.0005). 5) The incidence of positive intraperitoneal free cancer cells increased as the stage of gastric cancer increased, but the survival rate was decreased. 6) In the noncurative resection group, the incidence of positive intraperitoneal free cancer cells was higher, but the survival rate was lower, than in the curative resection group. The 3-year survival rates were higher for the patients with curative resection and negative intraperitoneal free cancer cells than for the patients with curative resection and positive intraperitoneal free cancer cells (P<0.0009). The difference in the 3-year survival rate between the noncurative resection with positive intraperitoneal free cancer cell group and the noncurative resection with negative intraperitoneal free cancer cell group was stastistically significant. (P<0.0000). 7) For the types of recurrence, hematogenous metastasis was the most common type of recurrence in the negative intraperitoneal free cancer cell group; peritoneal metastasis was the most common type of recurrence in the positive intraperitoneal free cancer cell group. In conclusion; at the time of gastrectomy, peritoneal lavage cystology is very impotant and basic examination which can help early detection of intraperitoneal free cancer cells. Therefore, when intraperitoneal free cancer cells are negative,radical curative gastrectoy make the high survival rate of patients.
Adenocarcinoma ; Gastrectomy ; Humans ; Incidence ; Neoplasm Metastasis ; Peritoneal Lavage ; Prognosis* ; Recurrence ; Serous Membrane ; Stomach Neoplasms ; Survival Rate

BACKGROUND: Although diagnostic peritoneal lavage (DPL) is a well-established, reliably objective method of diagnosis of intraperitoneal injury, it is too sensitive to be used as a absolute indicator for emergency laparotomy. Recently, Otomo et al, have devised a new DPL criteria specifically designed and modified the classics criteria to aid in diagnosis of intestinal injury. So the author studied the difference of diagnostic sensitivity, specificity, and accuracy between the new and classic criteria for intestinal injury. METHODS: The author reviewed retrospectively one hundred fifteen patients underwent DPL from January 1993 to August 1999. The author adopted the classic criteria positive for intestinal injury when the lavage fluid was white blood cell(WBC) > or = 500/mm3 and newly developed supplementary criteria positive when RBC > or = 100,000/mm3, the positive-negative borderline was adjusted to WBC > or = RBC/150, and when RBC <100,000/mm3, to WBC > or = 500/mm3. And analyzed the difference of sensitivity, specificity, and accuracy each other. RESULTS: Among 115 patients, the sensitivity, specificity, and accuracy for intestinal injury were 96.4%, 87.4%, and 89.6% for the new criteria, and 100%, 42.5%, and 56.5% for the classic criteria. After exclusion of 10 patients in whom-DPL was performed within 3 hours or after 18 hours from the time of injury, the sensitivity, specificity and accuracy for intestinal injury were 96.4%, 97.4%, and 97.1% for the new criteria, and 100%, 46.8%, and 61% for the classic criteria. When analyzed the time interval from injury to DPL in the new criteria, 105 patients that DPL was performed between 3 to 18 hours had 2 false-positive, while 115 patients regardless of DPL time 11 false-positive. CONCLUSIONS : The author concluded that the new criteria of DPL effluent performed between 3 to 18 hours from abdominal blunt trauma would be more specific and accurate indicator of intestinal perforation than the classic criteria. And this new criteria will be used as a reliable indicator for emergency laparotomy for that patients.
Diagnosis ; Emergencies ; Humans ; Intestinal Perforation ; Laparotomy ; Peritoneal Lavage* ; Retrospective Studies ; Sensitivity and Specificity ; Therapeutic Irrigation

PURPOSE: There has been debate on the use of peritoneal irrigation and drainage following gastric cancer surgery. This study was conducted to evaluate the usefulness of routine peritoneal irrigation and drainage following gastric cancer surgery, especially with regard to the perioperative leukocyte count. METHODS: Of 298 patients, 153 were enrolled in the test group (without peritoneal irrigation & drainage), between October 2001 and August 2002, and 145 in the control group (with peritoneal irrigation and drainage), between January 2001 and September 2001. The demographics, range of dissection, pathological staging, operation times, anesthesia times, fever, perioperative leukocyte counts and operative complications were retrospectively analyzed in these consecutive patients. RESULTS: It was found that there was no difference in the demographics, range of dissection, pathological staging and operative complications between the two groups. However, the operation times, anesthesia times, and mean length of hospitalization in the test group were significantly shorter than those in the control group. No significance differences were found between the two groups with regard to the perioperative leukocyte counts. CONCLUSION: The routine usage of peritoneal irrigation and drainage was found to be neither safe nor effective in gastric cancer surgery patients.
Anesthesia ; Demography ; Drainage* ; Fever ; Hospitalization ; Humans ; Leukocyte Count* ; Leukocytes* ; Peritoneal Lavage* ; Retrospective Studies ; Stomach Neoplasms*