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Laparoscopic peritoneal lavage in staging gastric and oesophageal cancer
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Dr Stephanie Needham
Dr Deborah Stocken
Bryan RT, Cruickshank NR, Needham SJ, Moffitt DD, Young JA, Hallissey MT, Fielding JWL
European Journal of Surgical Oncology
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Aims: Accurate staging of gastric, oesophageal and oesophagogastric cancer is essential to avoid unnecessary laparotomies in patients where only palliation is appropriate. This requires a multimodal approach utilizing endoscopy, computed tomography and laparoscopy. Previous authors have found that the presence of free peritoneal tumour cells (FPTCs) detected at laparoscopy or laparotomy confers a poorer prognosis. However, various methods of peritoneallavage are described. The aim of this study was to evaluate the prognostic value of our technique of peritoneallavage. Materials and methods: 88 staging laparoscopies with peritoneallavage were carried out between March 1997 and February 1999 on patients eligible for attempted curative resection of a gastric, oesophageal or oesophagogastric cancer. During laparoscopy the pelvis was irrigated with 200 ml of normal saline, with 100 ml aspirated and examined cytologically. Patients were followed-up until September, 1999. Results: 11 patients had FPTC-positive cytology with a median survival following laparoscopy of 122 days (95% CI 82–161) with only a single patient surviving more than one year. In the FPTC-negative group, median survival was 378 days (95% CI 256,-). Log-rank2=16.7, P<0.001. Conclusions: The presence of FPTCs detected by our technique is a contraindication to attempted curative resection – palliation only (medical or surgical) is appropriate.
W.B. Saunders Co. Ltd.
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