P-099 - The frequency of positive peritoneal washing in patients with T4a stage gastric cancer: long-term results of “radical” surgery

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Gastric Cancer
Surgery and/or Radiotherapy of Cancer
Presenter R. Bayramov
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors R. Bayramov, R. Abdullayeva, S. Huseynova, A. Huseynova
  • Azerbaijan Medical University, Baku/AZ

Abstract

Introduction

Peritoneal carcinomatosis constitutes one of the main causes of failure in long-term period following radical surgery for gastric cancer (GC). The main ground for development of peritoneal carcinomatosis in the postoperative long-term period is the existence of microcarcinomatosis on peritoneal surface during “radical” surgery that can't be detected visually. The aim of the study is to determine the risk of development of peritoneal carcinomatosis following “radical” surgery for T4a stage GC by means of studying the frequency of existence of the carcinoma cells in the peritoneal washing taken immediately after laparotomy.

Methods

The study enrolled some of the patients with T4a stage GC undergone radical surgery in the Department of Oncology, Azerbaijan Medical University from June 2007 till December 2012. After laparotomy the peritoneal surface in the subhepatic space and in the omental sack was irrigated by us with 20-40 ml saline before manipulating the stomach aselectively in 73 patients with GC of grate size estimated as T4a stage carcinoma visually. The F:M ratio was 1.8:1 and the mean age of the patients constituted 58 (32-74) years. In 24 patients cancer was located in the upper third, in 13 patients - in the middle third and in 36 patients - in the lower third of the stomach.

The aspirated peritoneal washing was examined pathologically. Irrespective of the results of pathological examination of the peritoneal washing in all 73 patients gastrectomy (total or subtotal) with extended lymph node dissection was carried out. The results of pathological examination of the resection specimens showed up adenocarcinoma-invaded serosa (T4a) in 54 patients (74%). In the rest of the patients the carcinoma was found to be T3 stage (invaded the subserosa) and T2 stage (invaded the muscularis propria) according to 7th Edition of AJCC/UICC. The 30-day postoperative mortality was 0%. All patients received adjuvant chemotherapy following surgery.

Results

When analyzing the results of pathologic examination of the peritoneal washing and resection specimens we determined that in no case of T3 and T2 stage GC peritoneal washing was positive whereas in 33 patients (61.1%) with T4a stage GC carcinoma cells were found in the peritoneal washing (p < 0.001). It was verified that the existence of the carcinoma cells in the peritoneal washing was an independent negative prognostic factor. So despite the fact that 5-year survival rate for the patients with T4a stage GC with negative peritoneal washing constituted 31.4%, no patient with positive peritoneal washing lived more than 20 months (p < 0.05).

Conclusion

The result of pathological examination of the peritoneal washing taken before the manipulation on stomach during revision after laparotomy for GC can be an independent factor affecting the surgical strategy. In case of positive peritoneal washing gastrectomy can be carried out without extended lymph node dissection.