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Revista Do Colegio Brasileiro de... 2020to assess whether laparoscopy with peritoneal lavage is superior to computed tomography for staging gastric adenocarcinoma and whether it can modify the surgical... (Comparative Study)
Comparative Study
OBJECTIVE
to assess whether laparoscopy with peritoneal lavage is superior to computed tomography for staging gastric adenocarcinoma and whether it can modify the surgical approach.
METHODS
we conducted a retrospective study of 46 patients with gastric adenocarcinoma treated by the digestive surgery team of the Passo Fundo Clinics Hospital (RS), from January 2015 to December 2018, and submitted to laparoscopy with preoperative peritoneal lavage. All patients underwent preoperative clinical staging with computed tomography.
RESULTS
of the 46 patients analyzed, the majority had tumors located in the cardia (34.8%), poorly differentiated (69.6%), and subtype signet ring cells (65.2%). In 91.3%, the computed tomography scan did not identify peritoneal carcinomatosis or distant metastasis. Among these patients with negative computed tomography for distant disease, 21.8% had positive peritoneal lavage for neoplastic cells and had their therapeutic approaches modified.
CONCLUSION
laparoscopy and peritoneal lavage altered the surgical decision in 21.8% of patients, providing a more reliable preoperative staging in gastric adenocarcinoma.
Topics: Adenocarcinoma; Aged; Digestive System Surgical Procedures; Female; Gastrectomy; Humans; Laparoscopy; Male; Middle Aged; Neoplasm Staging; Peritoneal Lavage; Preoperative Care; Retrospective Studies; Stomach Neoplasms; Tomography, X-Ray Computed
PubMed: 32022110
DOI: 10.1590/0100-6991e-20192314 -
Clinical & Translational Oncology :... Sep 2021To demonstrate whether extensive intraoperative peritoneal lavage (EIPL) could yield better results in overall survival and less recurrence, regardless of peritoneal... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To demonstrate whether extensive intraoperative peritoneal lavage (EIPL) could yield better results in overall survival and less recurrence, regardless of peritoneal cytology, compared to standard peritoneal lavage (SPL).
METHODS
A prospective randomised multicenter study including 94 patients (47 per arm) to detect a 20% difference in 3-year overall survival in patients with locally advanced tumours without peritoneal carcinomatosis. Three samples of peritoneal fluid were obtained (at the beginning, the end of procedure and after the assigned peritoneal lavage). Clinicopathological and surgical data were analysed by group. Postoperative complications, location of recurrence and surgical approach were evaluated. Overall survival was calculated by the Kaplan-Meier method and the uni/multivariate analysis for prognostic factors was carried out using Cox regression analysis.
RESULTS
A total of 86 patients were analysed (4 excluded per group). No statistical differences were observed in clinicopathological or surgical data between groups, considering both groups well-balanced for analysis. Overall survival at 3 years was 64.3% for SPL vs. 62.3% for EIPL (p 0.421). Only three patients had at least one positive peritoneal cytology (1:2). There were no differences regarding postoperative complications (SPL: 37.2% vs. EIPL: 32.5%, p 0.65) or between location of recurrence and number of recurrences. The number of recurrences did not differ between surgical approaches, but locoregional and peritoneal recurrences were fewer with the laparoscopic approach (p 0.048).
CONCLUSIONS
The regular use of extensive peritoneal lavage in patients with locally advanced gastric cancer, regardless of peritoneal cytology, has not been effective as prophylaxis of peritoneal recurrence or better survival.
Topics: Aged; Analysis of Variance; Chemotherapy, Adjuvant; Female; Humans; Intraoperative Care; Kaplan-Meier Estimate; Male; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Peritoneal Lavage; Peritoneal Neoplasms; Prospective Studies; Stomach Neoplasms
PubMed: 33792839
DOI: 10.1007/s12094-021-02596-8 -
Gastric Cancer : Official Journal of... Jan 2018Peritoneal cytology has been used as a part of the cancer staging of gastric cancer patients. The primary aim of this systematic review was to evaluate the value of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Peritoneal cytology has been used as a part of the cancer staging of gastric cancer patients. The primary aim of this systematic review was to evaluate the value of peritoneal cytology as part of the staging of gastric cancer and survival prediction. The second aim was to establish if positive cytology may be modified by neoadjuvant therapy, to improve prognosis.
METHODS
An electronic literature search was performed using Embase, Medline, Web of Science, and Cochrane library databases up to January 2016. The logarithm of the hazard ratio (HR) with 95% confidence intervals (CI) was used as the primary summary statistic. Comparative studies were used, and the outcome measure was survival in three groups: (1) positive versus negative cytology at staging laparoscopy immediately preceding surgery; (2) effect of neoadjuvant therapy on cytology and survival; and (3) positive cytology in the absence of macroscopic peritoneal disease was compared with obvious macroscopic peritoneal disease.
RESULTS
Pooled analysis demonstrated that positive cytology was associated with significantly reduced overall survival (HR, 3.46; 95% CI, 2.77-4.31; P < 0.0001). Interestingly, negative cytology following neoadjuvant chemotherapy was associated with significantly improved overall survival (HR, 0.42; 95% CI, 0.31-0.57; P < 0.0001). The absence of macroscopic peritoneal disease with positive cytology was associated with significantly improved overall survival (HR, 0.64; 95% CI, 0.56-0.73; P < 0.0001).
CONCLUSION
This study suggests that patients with initial positive cytology may have a good prognosis following neoadjuvant treatment if the cytology results change to negative after treatment.
Topics: Adenocarcinoma; Aged; Female; Humans; Male; Middle Aged; Neoplasm Staging; Peritoneal Lavage; Prognosis; Stomach Neoplasms
PubMed: 28779261
DOI: 10.1007/s10120-017-0749-y -
International Journal of Surgery... Feb 2017Laparoscopic peritoneal lavage (LPL) has been proposed as an alternative, less invasive technique in the treatment of acute perforated sigmoid diverticulitis (APSD). The... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Laparoscopic peritoneal lavage (LPL) has been proposed as an alternative, less invasive technique in the treatment of acute perforated sigmoid diverticulitis (APSD). The aim of this meta-analysis is to compare the effectiveness of LPL versus surgical resection (SR) in terms of morbidity and mortality in the management of APSD.
METHODS
A comprehensive search was conducted for randomised controlled trials (RCTs) comparing LPL versus SR in the treatment of APSD. The end points included peri-operative mortality, severe adverse events, overall mortality, post-operative abscess, percutaneous reinterventions, reoperation, operative time, postoperative stay, and readmissions.
RESULTS
Three RCTs with a total of 372 patients, randomised to either LPL or SR were included. There was no significant difference in peri-operative mortality between LPL and SR (OR 1.356, 95% CI 0.365 to 5.032, p = 0.649), or serious adverse events (OR = 1.866, 95% CI = 0.680 to 5.120, p = 0.226). The LPL required significantly less time to complete than SR (WMD = -72.105, 95% CI = -88.335 to -55.876, p < 0.0001). The LPL group was associated with a significantly higher rate of postoperative abscess formation (OR = 4.121, 95% CI = 1.890 to 8.986, p = 0.0004) and subsequent percutaneous interventions (OR = 5.414, 95% CI 1.618 to 18.118, p = 0.006).
CONCLUSION
Laparoscopic peritoneal lavage is a safe and quick alternative in the management of APSD. In comparison to SR, LPL results in higher rates of postoperative abscess formation requiring more percutaneous drainage interventions without any difference in perioperative mortality and serious morbidity.
Topics: Diverticulitis, Colonic; Humans; Intestinal Perforation; Laparoscopy; Peritoneal Lavage; Randomized Controlled Trials as Topic; Reoperation; Treatment Outcome
PubMed: 28089941
DOI: 10.1016/j.ijsu.2017.01.020 -
International Journal of Clinical... Jul 2021The prognostic value of positive intraoperative peritoneal cytology and lavage cytology, including the differences in their prognostic impact, in colorectal cancer is...
BACKGROUND
The prognostic value of positive intraoperative peritoneal cytology and lavage cytology, including the differences in their prognostic impact, in colorectal cancer is controversial. We aimed to investigate the prognostic values of positive peritoneal cytology and lavage cytology findings for colorectal cancer and compare their prognostic impact.
METHODS
We retrospectively evaluated 592 clinical stage II-IV colorectal cancer patients who underwent peritoneal cytology (n = 225) or lavage cytology (n = 367) between November 1993 and December 2018. The prognostic factors for cancer-specific survival were identified, and the differences in cancer-specific survival were examined between the patients.
RESULTS
The cytology-positive rate was 10.8% (64/592), 17.8% (40/225), and 6.5% (24/367) in the overall, peritoneal cytology, and lavage cytology groups, respectively. Both positive peritoneal cytology (hazard ratio: 2.196) and lavage cytology (hazard ratio: 2.319) were independent prognostic factors. The peritoneal cytology-positive group showed significantly poorer cancer-specific survival than the cytology-negative group (5-year: 3.5% vs. 59.5%; 10-year: 3.5% vs. 46.1%, p < 0.001). Similar results were obtained for lavage cytology (5-year: 14.1% vs. 73.9%; 10-year: 4.7% vs. 63.5%, p < 0.001). The cancer-specific survival was not significantly different between the peritoneal cytology-positive and lavage cytology-positive groups (p = 0.058). Both positive peritoneal and lavage cytology were associated with poorer cancer-specific survival across all colorectal cancer stages.
CONCLUSIONS
Positive peritoneal and lavage cytology are associated with worse cancer-specific survival in colorectal cancer. The prognostic impact was comparable between positive lavage and peritoneal cytology. Thus, cytology should be a standard assessment modality for colorectal cancer.
Topics: Colorectal Neoplasms; Cytodiagnosis; Humans; Neoplasm Staging; Peritoneal Lavage; Prognosis; Retrospective Studies
PubMed: 33844111
DOI: 10.1007/s10147-021-01918-8 -
Journal of Investigative Surgery : the... Jun 2022The role of Ca-125 in endometrial cancer is not fully known. Some authors have reported high Ca-125 levels in patients with recurrent or advanced endometrial cancer,...
Correlation of Preoperative Serum and Intraoperative Peritoneal Lavage Fluid Ca-125 Levels with Postoperative Tumor Histology in Patients with Endometrial Cancer: A Prospective-Controlled Study.
BACKGROUND
The role of Ca-125 in endometrial cancer is not fully known. Some authors have reported high Ca-125 levels in patients with recurrent or advanced endometrial cancer, whereas others have stated that Ca-125 levels and the advance of the disease were not correlated in endometrial cancer. This makes it inevitable for clinicians to search for different measurement methods or interpretation of the present tumor markers. The aim of this study was to evaluate the relationship between Ca-125 values of the serum and abdominal lavage fluid and postoperative histopathological parameters in patients with endometrial carcinoma.
METHODS
The study included patients who were diagnosed with endometrial cancer in the Gynecology Clinic and were planned to undergo surgery. The correlations of clinicopathological parameters with preoperative values of Ca-125 measured from serum and abdominal lavage fluid were investigated. The Spearman correlation test was applied in the analysis of correlations of serum and abdominal lavage fluid Ca-125 values with postoperative tumor characteristics.
RESULTS
The serum Ca-125 values were determined to be positively correlated with surgical stage, tumor diameter, and lymph node involvement (p = 0.03; p = 0.04; and p = 0.01, respectively). No correlation was determined between tumor grade and serum Ca-125 level. The level of Ca-125 in the abdominal lavage fluid was observed to be correlated with surgical stage and tumor grade, but not with tumor diameter or lymph node involvement (p = 0.01, p = 0.04, respectively).
CONCLUSIONS
The value of Ca-125 in the abdominal lavage fluid has a positive correlation with the surgical stage and tumor grade in patients with endometrial carcinoma.
Topics: Ascitic Fluid; Biomarkers, Tumor; CA-125 Antigen; Endometrial Neoplasms; Female; Humans; Neoplasm Staging; Peritoneal Lavage; Preoperative Period; Prospective Studies
PubMed: 34991426
DOI: 10.1080/08941939.2021.2024307 -
Indian Journal of Surgical Oncology Dec 2016The survival rates of gastric cancer patients with cytology-positive peritoneal lavage fluid without macroscopic dissemination (CY+/P-) is the same as that of patients...
The survival rates of gastric cancer patients with cytology-positive peritoneal lavage fluid without macroscopic dissemination (CY+/P-) is the same as that of patients with overt peritoneal metastasis.The 5-year survival rate of such patients is only 2%. The current study aims to highlight its significance in the staging of gastrointestinal malignancies and its implications for patient care. Prospective nonrandom analysis of peritoneal wash cytology in patients with gastrointestinal malignancies was conducted in the department of Surgical Gastroenterology, Nizams Institute of Medical Sciences, Hyderabad from January 2012 to June 2013. Descriptive statistics and ANOVA variance analysis was performed to estimate incidence, risk factors and the effect of surgery in causing peritoneal dissemination of malignancy. A total of 60 patients with operable gastric cancer underwent peritoneal lavage for evaluation of malignant cells. The incidence of Positive peritoneal lavage cytology was 8.3% (5/60).Four patients with positive lavage fluid belong to T3 stage (11.7%, p-0.309).Poorly differentiating and mucinous tumors had a higher incidence of positive cytology (18.1% and 25%).None of the patients with positive cytology had positive resection margin. Tumors with advanced T stage, lymph nodal involvement, lympho-vascular and perineural invasion have higher incidence of positive peritoneal cytology. Surgical handling has a negligible effect in peritoneal dissemination of tumor. Large scale studies are warranted to validate the findings and define it's role in management of gastric cancer.
PubMed: 27872531
DOI: 10.1007/s13193-016-0527-z -
Anticancer Research May 2023Peritoneal lavage cytology positivity (CY1) has been identified as a prognostic factor for distant metastases that is equivalent to peritoneal dissemination in Japan....
BACKGROUND
Peritoneal lavage cytology positivity (CY1) has been identified as a prognostic factor for distant metastases that is equivalent to peritoneal dissemination in Japan. Peritoneal lavage cytology is usually diagnosed by microscopic findings; a diagnostic procedure using a liquid biopsy (LB) technique has not yet been established.
PATIENTS AND METHODS
We evaluated the feasibility of a LB approach using peritoneal lavage samples from 15 patients with gastric cancer. Samples were collected from both the Douglas pouch and the left subdiaphragmatic area, and cell-free DNA was extracted for analysis of TP53 mutations using droplet digital polymerase chain reaction.
RESULTS
All 10 patients with CY1 had positive cytology for the left subdiaphragmatic specimen. However, only six out of the 10 patients had positive cytology for their Douglas pouch specimens, and these six patients had peritoneal tumor DNA (ptDNA) in these specimens. In all five patients with CY0, ptDNA was not detected. The overall survival was significantly shorter in the ptDNA-positive group than in the ptDNA-negative group. The survival of the group with a high amount of DNA from free intraperitoneal cells (ficDNA) was significantly worse than that of those with a low amount. In contrast, the group with a high amount of DNA from peritoneal cell-free DNA (pcfDNA) had significantly better survival than the group with a low amount.
CONCLUSION
LB cytology showed equivalent utility to that of conventional microscopic examinations regarding its diagnostic ability. Therefore ptDNA, pcfDNA and ifcDNA are expected to be useful as prognostic factors.
Topics: Humans; Peritoneal Lavage; Stomach Neoplasms; Peritoneal Neoplasms; Prognosis; Biomarkers
PubMed: 37097663
DOI: 10.21873/anticanres.16367 -
Annals of Clinical and Laboratory... Jan 2022To investigate the diagnostic value of tumor markers in peritoneal lavage fluid in the diagnosis of peritoneal metastasis from colorectal cancer.
OBJECTIVE
To investigate the diagnostic value of tumor markers in peritoneal lavage fluid in the diagnosis of peritoneal metastasis from colorectal cancer.
METHODS
One hundred eighty-six patients with colorectal cancer and 15 patients with benign disease who underwent surgical treatment were included. The abdominal cavity and pelvis of the patients were lavaged with 200 ml of normal saline immediately after abdominal cavity incision or pneumoperitoneum establishment. Five milliliters of lavage fluid was collected for peritoneal lavage fluid tumor marker detection (pCEA, pCA19-9, pCA125 and pCA724), and another 100 ml of lavage fluid was collected for cytological examination.
RESULTS
There were 13 patients with abdominal and pelvic nodules found intraoperatively and confirmed by postoperative pathology as peritoneal metastasis, and 24 patients were cytologically peritoneal lavage-positive, with a positivity rate of 12.9%. Peritoneal metastasis from colorectal cancer was related to tumor T stage, N stage, and serum CEA and CA19-9 elevation. Peritoneal lavage fluid tumor markers had diagnostic value for patients with and without peritoneal metastasis from colorectal cancer, and the differences were statistically significant (<0.05). Among them, pCA19-9 had the highest area under the curve (AUC), with 84.62% sensitivity and 85.19% specificity at the cutoff value. pCA19-9 had diagnostic value for peritoneal micrometastasis from colorectal cancer (<0.05), with an AUC of 0.72.
CONCLUSION
T stage, N stage, and serum CEA and CA19-9 elevation are associated with peritoneal metastasis from colorectal cancer. Peritoneal lavage fluid tumor markers have diagnostic value for peritoneal metastasis from colorectal cancer, among which pCA19-9 has the highest diagnostic value.
Topics: Ascitic Fluid; Biomarkers, Tumor; Carcinoembryonic Antigen; Colorectal Neoplasms; Humans; Peritoneal Lavage; Peritoneal Neoplasms; Prognosis; Stomach Neoplasms
PubMed: 35181622
DOI: No ID Found -
Therapeutic Hypothermia and Temperature... Jan 2022To investigate the effects of different amounts of lavage fluids on vital signs, inflammatory response, main organ function, and electrolytes on dogs with...
To investigate the effects of different amounts of lavage fluids on vital signs, inflammatory response, main organ function, and electrolytes on dogs with seawater-immersed open abdominal injury by portable peritoneal lavage device. Twenty dogs were randomly divided into four groups according to different irrigation volume and irrigation time, they were divided into group A (50 mL/min, 1 hour, 3 L), group B (50 mL/min, 1.5 hours, 4.5 L), group C (50 mL/min, 2 hours, 6 L) and group D (50 mL/min, 3 hours, 9 L). Seawater-immersed open abdominal injury dog model was developed and portable peritoneal lavage device was used for lavaging and rewarming. The change of blood pressure, body temperature, heart beat rate, serum tumor necrosis factor-α, interleukin-6, superoxide dismutase, and other indicators of each group were observed before and after immersion, and immediately, 1, 3, and 5 days after lavage. Immediately after lavage, the body temperature, mean arterial pressure, and heart rate of each group gradually recovered to normal, and the recovery rate of group C was faster than that of group A and group B. The indicator of central venous pressure (CVP) continued to decrease immediately after lavaging. CVP in group C was lower than that of groups A and B ( < 0.05, respectively). The inflammatory response was enhanced in all groups after immersion and after lavage, and reached the highest level at 1 day after lavage. The level of interleukin-1β in group C was significantly lower than that in group A ( < 0.05) and no significant difference when compared with other groups on 1 day after lavage. Three days after lavage, all indexes gradually decreased to the level of preinjury. Alanine transaminase (ALT) and lactic dehydrogenase reached the highest level on 1 day after lavage, and the level of ALT in group C was lower than that in group A ( < 0.05). On 1 and 3 days after lavage, the level of Na in group C was lower than those in group A ( < 0.05) and no significant difference compared with those in group B and group D. Application of the portable abdominal lavage device with 6 L of lavage fluid (group C) has the best effect of treatment for seawater-immersed open abdominal injury, which can maintain better vital signs and reduce inflammation.
PubMed: 35049396
DOI: 10.1089/ther.2021.0024