Reappraisal of Peritoneal Washing Cytology in 984 Patients with Pancreatic Ductal Adenocarcinoma Who Underwent Margin-Negative Resection

• DOI: 10.1007/s11605-014-2637-7
• Publication Date: 2014-10-14T18:22:20Z
• Authors: Sohei Satoi; Yoshiaki Murakami; Fuyuhiko Motoi; Kenichiro Uemura; Manabu Kawai; Masanao Kurata; Masayuki Sho; Ippei Matsumoto; Hiroaki Yanagimoto; Tomohisa Yamamoto; Masamichi Mizuma; Michiaki Unno; Yasushi Hashimoto; Seiko Hirono; Hiroki Yamaue; Goro Honda; Minako Nagai; Yoshiyuki Nakajima; Makoto Shinzeki; Takumi Fukumoto; A-Hon Kwon
• Keywords: Adult; Aged, 80 and over; Male; Middle Aged; 3. Good health; Pancreatic Neoplasms; Survival Rate; 03 medical and health sciences; Pancreatectomy; 0302 clinical medicine; Japan; Humans; Female; Peritoneum; Aged; Carcinoma, Pancreatic Ductal; Neoplasm Staging; Retrospective Studies

The objective of the present study was to reappraise the clinical value of peritoneal washing cytology (CY) in 984 pancreatic ductal adenocarcinoma patients who underwent margin-negative resection.In a 2001-2011 database from seven high-volume surgical institutions in Japan, 69 patients (7%) had positive CY (CY+ group) indicative of M1 disease and 915 patients had negative CY (CY- group). Clinicopathological data and survival were compared between groups.Significant correlations between CY+ and high CA19-9 level, pancreatic body and tail cancer, lymph node metastasis, and a lower frequency of R0 resection were observed. Overall survival (OS) of CY+ patients was significantly worse than that of CY- patients (median survival time [MST], 16 vs. 25 months; 3-year OS rate, 6 vs. 37%; p < 0.001). CY+ patients had a significantly higher rate of post-operative peritoneal carcinomatosis than CY- patients (48 vs. 21%; p < 0.001). Administration of adjuvant chemotherapy did not provide a favorable survival outcome to CY+ patients. The current study showed that patients with M1 disease had acceptable MST after margin-negative resection and a high incidence of peritoneal carcinomatosis within 3 years after surgery, resulting in decreased long-term survival. The development of a new strategy to control peritoneal carcinomatosis when surgical resection is performed in such patients is required.