Abdulla Kunnummal Palathinkara1, Rajesh Mithalavalaram Raghavan2, Sasi Malayan Parambil3
BACKGROUND
The presence of intra-peritoneal free cancer cells (IPFCC) in adenocarcinoma stomach has been proven to be associated with grim prognosis and is staged as M1 disease in latest TNM staging. Major resections are not indicated in these patients that will add to the morbidity and increase the cost and duration of hospital stay and also delay the commencement of palliative chemotherapy.
MATERIALS AND METHODS
Study was conducted in a tertiary care apex institute in Kerala, India. 60 consecutive cases of clinically and radiologically proven non-metastatic adeno carcinoma stomach with tissue diagnosis, who were being planned for curative resection, were selected and subjected to preoperative laparoscopic peritoneal washing. 300 ml of normal saline was introduced to peritoneal cavity. Which was aspirated after irrigating all surfaces of the peritoneal cavity. Sample was centrifuged, stained with Papanicolaou stain and cytological analysis for IPFCC was done from the Department of Pathology. Statistical analysis was done using SPSS software version 18.1 and p-value <.05 was considered as significant.
RESULTS AND DISCUSSION
31.6% (19 cases) of the clinically and radiologically proven non-metastatic adenocarcinoma stomach were restaged as metastatic disease after laparoscopic peritoneal wash cytology analysis. Of them 14(23.3% of the sample) had visible peritoneal metastasis found during laparoscopic inspection, but the remaining 5 cases did not have visible peritoneal metastasis but were positive for IPFCC which could be detected only after peritoneal wash cytology analysis and not by mere laparoscopic inspection, which accounts for 10.8% of those who were labeled as non-metastatic and curable even after preoperative diagnostic laparoscopy.
CONCLUSION
Preoperative laparoscopy and peritoneal wash cytology analysis is mandatory in clinically and radiologically proven non-metastatic carcinoma stomach, who are being planned for curative resection. Unnecessary surgery will increase morbidity and mortality.
