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.

Gastrointestinal cancer peritoneal metastasis(GICPM) is one of the biggest challenges of clinical treatment. The ultimate solution to the problem requires the clinicians to accurately understand cytologic and molecular pathological mechanisms behind GICPM, and apply such knowledge in the clinical decision-making process for diagnosis and treatment of individual patient, so as to realize "prevention" and "treatment" proactively. The core cytopathological mechanisms behind GICPM, which are closely related to clinical treatment decisions, are as follows: (1) free cancer cells or clusters in peritoneal cavity colonize the peritoneum, resulting in irreversible pathological damage to peritoneal mesothelial cells; (2) the colonized cancer cells further invade the specific structure of the peritoneal milky spots and initiate an accelerated invasive growth process; (3) the process of peritoneal interstitial fibrosis aggravates the structural destruction of the peritoneum; (4) the interaction between cancer cells and immune cells in the milk spots forms a permissive immune microenvironment that promotes the growth of peritoneal metastatic cancer. These four core cytopathological mechanisms are mutually causal and promote each other, forming a vicious circle of GICPM development. As long as clinicians accurately understand these four points, it is possible to grasp the opportunity of clinical diagnosis and treatment, change reactive and passive treatment into preventive and proactive treatment, and improve the clinical diagnosis and treatment landscape of GICPM.
Humans ; Intestinal Neoplasms ; Peritoneal Cavity ; Peritoneal Neoplasms ; Peritoneum ; Tumor Microenvironment

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*

Peritoneal metastasis is considered as the end stage of gastric cancer, which is a fatal malignancy without the chance of surgery. No standard regimens are recommended. Routine treatments can not improve the survival of these patients, while multidisciplinary treatments may probably be promising. Aggressive treatments such as cytoreductive surgery, intra-peritoneal chemotherapy and bidirectional chemotherapy are applied to clinical management in recent years. Furthermore, molecular targeted therapy and immune therapy are developed and making individualized treatment possible. Individualized treatment according to clinical characteristics and expression of biomarkers will be the future of peritoneal metastasis of gastric cancer.
Combined Modality Therapy ; Humans ; Peritoneal Neoplasms ; Precision Medicine ; Stomach Neoplasms

INTRODUCTION: Primary peritoneal carcinoma (PPC) is an uncommon malignancy and is often misdiagnosed as peritoneal carcinomatosis from metastatic gastrointestinal carcinoma and more frequently from ovarian carcinomas due to a common embryonic origin of the ovary and the peritoneum. Its diagnosis is a challenge for clinicians. Herein, we report a rare case of PPC in a 72-year-old woman who was initially suspected with metastatic ovarian malignancy, and emphasizes points that help differentiate PPC from primary ovarian cancer. CASE: This a case of a 72-year-old female with abdominal discomfort and distension, initially diagnosed with ovarian carcinoma, with abdominal CT scan revealing thickening of the omentum multiple enhancing nodules in the left adnexa, within the pouch of Douglas and subdiaphragmatic region compatible with malignancy such as metastases from carcinoma. Cancer antigen (CA) 125 (3476 u/mL) and CA 15-3 (45.94 u/mL) were elevated. The patient underwent dilation and curettage and diagnostic laparoscopy and biopsy with frozen section, which revealed metastatic clear cell adenocarcinoma, favoring primary ovarian carcinoma. The patient then underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy with bilateral lymph node dissection, and omentectomy. Further histopathological findings later confirmed that the patient had carcinoma primarily from the peritoneum instead of from the ovary. The patient was discharged, improved and underwent chemotherapy post-operation. CONCLUSION: This report emphasizes how to distinguish primary malignancy from the peritoneum from that in the ovary, preventing misdiagnosis. The emphasis in considering primary peritoneal cancer as a differential diagnosis in patients with abdominal symptoms suspected due to malignancy should be noted.
Peritoneal Neoplasms Carcinoma, Ovarian Epithelial ; Ovarian Neoplasms ; Carcinoma

Modern clinical oncology has made great achievements over the last century. However, peritoneal metastasis from gastrointestinal cancer, as one of three most common metastasis modalities, was not re-recognized until the end of the last century, and a normative diagnosis and treatment system has been gradually beginning to be formed until today. This comment is to review the development history, reflect on the lessons and experiences in clinical practice, analyze the difficulties on redefinition, deep understanding and clinical management, and pain points on theory construction, technique practice and discipline construction, in the field of gastrointestinal cancer peritoneal metastasis. We suggested a solution to the difficulties and pain points by realizing the fact of burden of peritoneal metastasis, reinforcing technical training, and promoting collaborative researches, aiming to provide reference for the steady development of peritoneal surface oncology.
Humans ; Peritoneal Neoplasms/secondary* ; Gastrointestinal Neoplasms ; China ; Pain

Female ; Humans ; Ovarian Neoplasms/surgery* ; Peritoneal Neoplasms ; Teratoma/surgery*

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

PURPOSE: This study is aimed to evaluate the efficacy of a novel method (RT-PCR for CEA) to diagnose free cancer cells in peritoneal cavity of gastric cancer patients, which can be used as a indication of prophylactic treatment to prevent peritoneal recurrence after curative resection of gastric cancer. MATERIALS AND METHODS: 114 gastric adenocarcinoma patients were included for this study. With pellet of peritoneal washing fluid, cytology and RT-PCR for CEA were performed with specific primers. RESULTS: Positive rate of PCR as a whole was 55.3% (63 cases); however, that of cytology was 15.8% (18 cases). Positive rate of PCR increased with depth of invasion of the lesion (p=0.026); however, that of cytology didn't (p=0.233). In early gastric cancer and seeding cases, PCR was not more sensitive than cytologic examination in detection of free cancer cell, but in pm, ss and si cancers, PCR was much more sensitive than cytology (p<0.001). CONCLUSION: PCR was more sensitive to diagnose free cancer cells in peritoneal cavity of gastric cancer patients especially in pm, ss and si cancers than conventional cytologic examination, and it can be a good candidate of indication of prophylactic treatment to prevent peritoneal recurrence after curative resection.
Adenocarcinoma ; Humans ; Peritoneal Cavity ; Polymerase Chain Reaction ; Recurrence ; Stomach Neoplasms*

Female ; Humans ; Lipoma ; diagnosis ; surgery ; Omentum ; surgery ; Peritoneal Neoplasms ; surgery