Immunocytochemically detected free peritoneal tumour cells (FPTC) are a strong prognostic factor in gastric carcinoma Prospective validation of quantitative CEA mRNA detection in peritoneal washes in gastric carcinoma patients Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Improves Survival of Patients with Peritoneal Carcinomatosis from Gastric Cancer: Final Results of a Phase III Randomized Clinical Trial Positive Peritoneal Cytology in Patients with Gastric Cancer: Natural History and Outcome of 291 Patients Prospective study of the quantitative carcinoembryonic antigen and cytokeratin 20 mRNA detection in peritoneal washes to predict peritoneal recurrence in gastric carcinoma patients. Conventional Cytology Is Not Beneficial for Predicting Peritoneal Recurrence after Curative Surgery for Gastric Cancer: Results of a Prospective Clinical Study The Value of Peritoneal Cytology as a Preoperative Predictor in Patients With Gastric Carcinoma Undergoing a Curative Resection Does the intraoperative peritoneal lavage cytology add prognostic information in patients with potentially curative gastric resection? Prognostic value of microscopic peritoneal dissemination Optimal surgical strategy for potentially curable serosa-involved gastric carcinoma with intraperitoneal free cancer cells. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. Prognostic value of positive cytology findings from abdominal washings in patients with gastric cancer The utility of pre-operative peritoneal lavage examination in serosa-invading gastric cancer patients. The clinical importance of a transcription reverse-transcription concerted (TRC) diagnosis using peritoneal lavage fluids in gastric cancer with clinical serosal invasion: a prospective, multicenter study. Prognostic significance of peritoneal lavage cytology in gastric cancer in Singapore Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. Extensive Intraoperative Peritoneal Lavage as a Standard Prophylactic Strategy for Peritoneal Recurrence in Patients with Gastric Carcinoma Peritoneal washing cytology: prognostic value of positive findings in patients with gastric carcinoma undergoing a potentially curative resection. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin.
Summary We prospect ively investigated the prognostic significance of free peritoneal tumour cells ( FPTC ) in a series of 118 patients with completely resected gastric carcinoma .  Immunocytochemistry with the monoclonal antibody Ber-Ep4 was performed on cytospins from intraoperative peritoneal lavage specimens . Twenty-three patients ( 20 % ) had FPTC  which was significantly correlated with pT and pN categories , stage , tumour size , lymphatic invasion , Laurèn and WHO classifications and perigastric adipose tissue metastases . The median survival time for all FPTC positive compared with negative patients was significantly shorter ( 11 compared with > 72 months ) , with estimated 5-year survival rates of 8 % vs. 60 % . None of the patients with FPTC had an early gastric cancer . In advanced tumour subgroups without and with serosal invasion ( n = 59 and 35 ) , there were 19 % and 34 % with FPTC .  Multivariate survival analysis showed nodal status , FPTC , mesenteric lymphangiosis , and lymph node metastasis to the compartment III to be independent prognostic factors with relative risks of 6.6 , 4.5 , 2.9 and 2.2 respectively . Recurrent disease occurred in 91 % of FPTC-positive and in 38 % of FPTC-negative patients . FPTC had a positive predictive value of 91 % and a specificity of 97 % for tumour recurrence .  FPTC is a strong negative , independent prognostic indicator for survival in gastric carcinoma Prediction of peritoneal relapse is extremely important for gastric cancer patients after curative surgery . The present study prospect ively vali date s the prognostic ability of quantifying carcinoembryonic antigen ( CEA ) mRNA in peritoneal washes by real-time reverse transcriptase – polymerase chain reaction . Based on a retrospective study of 197 curatively resected gastric cancer patients ( training set ) , we determined a cutoff value of CEA mRNA using receiver-operating characteristic curve . We used this cutoff value to vali date the risk of peritoneal recurrence in a new cohort of 86 gastric cancer patients ( validation set ) between July 2000 and December 2002 in a prospect i ve study . During the median 30 months of postoperative surveillance , 20 of the 86 patients died , and 13 of the 20 developed peritoneal metastases . Peritoneal recurrence-free survival as well as overall survival was significantly worse in patients with positive CEA mRNA ( P<0.0001 ) . Multivariate analysis with the Cox proportional hazards model showed that positive CEA mRNA was a significant independent risk factor with both survival ( P=0.0130 ) and peritoneal recurrence-free survival ( P=0.0006 ) as end points . These results indicate that quantitation of CEA mRNA in peritoneal washes is a reliable prognostic indicator of peritoneal recurrence in the clinical setting Background This r and omized phase III study was to evaluate the efficacy and safety of cytoreductive surgery ( CRS ) plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) for the treatment of peritoneal carcinomatosis ( PC ) from gastric cancer . Methods Sixty-eight gastric PC patients were r and omized into CRS alone ( n = 34 ) or CRS + HIPEC ( n = 34 ) receiving cisplatin 120 mg and mitomycin C 30 mg each in 6000 ml of normal saline at 43 ± 0.5 ° C for 60–90 min . The primary end point was overall survival , and the secondary end points were safety profiles . Results Major clinicopathological characteristics were balanced between the 2 groups . The PC index was 2–36 ( median 15 ) in the CRS + HIPEC and 3–23 ( median 15 ) in the CRS groups ( P = 0.489 ) . The completeness of CRS score ( CC 0–1 ) was 58.8 % ( 20 of 34 ) in the CRS and 58.8 % ( 20 of 34 ) in the CRS + HIPEC groups ( P = 1.000 ) . At a median follow-up of 32 months ( 7.5–83.5 months ) , death occurred in 33 of 34 ( 97.1 % ) cases in the CRS group and 29 of 34 ( 85.3 % ) cases of the CRS + HIPEC group . The median survival was 6.5 months ( 95 % confidence interval 4.8–8.2 months ) in CRS and 11.0 months ( 95 % confidence interval 10.0–11.9 months ) in the CRS + HIPEC groups ( P = 0.046 ) . Four patients ( 11.7 % ) in the CRS group and 5 ( 14.7 % ) patients in the CRS + HIPEC group developed serious adverse events ( P = 0.839 ) . Multivariate analysis found CRS + HIPEC , synchronous PC , CC 0–1 , systemic chemotherapy ≥ 6 cycles , and no serious adverse events were independent predictors for better survival . Conclusions For synchronous gastric PC , CRS + HIPEC with mitomycin C 30 mg and cisplatin 120 mg may improve survival with acceptable morbidity Background .Positive peritoneal cytology is a predictor of poor survival in patients with gastric cancer . Our aim is to more clearly define the natural history of this cohort . Methods . Review of a prospect ively maintained gastric cancer data base of patients who had diagnostic laparoscopy with peritoneal washings .  Clinicopathologic and treatmentrelated variables were obtained . Univariate and multivariate analyses were performed for factors associated with disease-specific survival ( DSS ) . Results .From January 1993 to April 2009 , a total of 1241 patients with gastric cancer underwent laparoscopy with peritoneal washings ; 291 ( 23 % ) had positive cytology . There were 198 patients ( 68 % ) who had visible metastases discovered at laparoscopy ( M1 ) , and 93 patients ( 32 % ) were without gross evidence of advanced disease ( M1 Cyt+ ) . The median DSS for the entire cohort was 1 year ; for M1 , DSS was 0.8 years , and for M1 Cyt+ , DSS was 1.3 years . At baseline , independent predictors of worse DSS were poor performance status , M1 disease , and diffuse tumors . Among the subset of patients with M1 Cyt + disease , performance status was the strongest independent predictor of DSS . A total of 48 of the 291 Cyt + patients had repeat staging laparoscopy after chemotherapy . Compared with patients who had persistently positive cytology ( n = 21 ) , those who converted to negative cytology ( n = 27 ) had a significant improvement in DSS ( 2.5 years vs. 1.4 years , P = 0.0003 ) . Conclusions . Patients with positive cytology as the only evidence of advanced disease exhibit a poor outcome ; however , clearing of Cyt + disease by chemotherapy is associated with a statistically significant improvement in DSS . The role for gastrectomy in patients with positive peritoneal cytology remains uncertain The prediction of peritoneal recurrence in gastric cancer patients is extremely important in preventing an unfavorable prognosis . In this prospect i ve study , we examined the usefulness of the carcinoembryonic antigen ( CEA ) and cytokeratin 20 ( CK20 ) mRNA detection in peritoneal washes as a prophylactic tool for peritoneal recurrence . Peritoneal washes were obtained from 164 patients with gastric carcinoma during a laparotomy .  CEA , CK20 and glyceraldehyde-3-phosphate-dehydrogenase mRNA levels in the peritoneal washes were detected by real-time reverse transcription-polymerase chain reaction ( RT-PCR ) using LightCycler . Molecular detection of the CEA and CK20 mRNA in the peritoneal washes by real-time RT-PCR showed a significant correlation with tumor size , histological type , depth of invasion , lymphatic invasion , venous invasion , lymph node metastasis , peritoneal dissemination , stage and cytology . The peritoneal recurrence-free survival and overall survival rates of CEA and CK20 mRNA-positive patients were significantly worse than those of marker gene-negative patients . The CEA and CK20 mRNA levels in the peritoneal washes were a significant independent prognostic factor . In conclusion , our prospect i ve study demonstrates that the detection of CEA and CK20 mRNA by quantitative real-time RT-PCR is a useful tool for identifying patients at high risk of peritoneal recurrence who may need adjuvant chemotherapy Purpose The role of peritoneal washing cytology in determining further treatment strategies after surgery for gastric cancer remains unclear . One reason for this is the fact that optimal procedures to increase the accuracy of predicting peritoneal metastasis have not been established . The aim of this study was to evaluate the efficacy of cytology using sample s harvested from two different abdominal cavity sites during gastric cancer surgery . Material s and Methods We prospect ively recruited 108 patients who were clinical ly diagnosed with locally advanced gastric cancer ( higher than cT1 stage disease ) .  Peritoneal washing fluids were collected from the pouch of Douglas and the subphrenic area . Patients were prospect ively followed up for 2 years to determine the recurrence and survival rates . Results Thirty-three patients dropped out of the study for various reasons , so 75 patients were included in the final analysis . Seven patients ( 9.3 % ) showed positive cytology findings , of whom , three showed peritoneal recurrence . Tumor size was the only factor associated with positive cytology findings ( P=0.037 ) . The accuracy and specificity of cytology  for predicting peritoneal recurrence were 90.1 % and 94.2 % , respectively , whereas the sensitivity was 50.0 % . The survival rate did not differ between patients with positive cytology findings and those with negative cytology findings ( P=0.081 ) . Conclusions Peritoneal washing cytology using sample s harvested from two different sites in the abdominal cavity was not able to predict peritoneal recurrence or survival in gastric cancer patients . Further studies will be required to determine whether peritoneal washing cytology during gastric cancer surgery is a meaningful procedure Background Although positive peritoneal cytology is associated with poor prognosis , it has not been found to be independently predictive of outcome when evaluated in context of post-resection pathologic T and N stage . This study was undertaken to evaluate the predictive value of positive cytology in context of other prognostic factors available prior to surgery in patients undergoing R0 resection for gastric cancer , to assess its role in selecting patients for appropriate treatment prior to surgical resection . Methods Clinical variables for all patients undergoing R0 resection for gastric adenocarcinoma at Memorial Sloan-Kettering Cancer Center from 1993–2002 were review ed from a prospect i ve data base . Patients underwent preoperative assessment of T and N stage with CT scan , laparoscopy , and endoscopic and /or laparoscopic ultrasound . Peritoneal cytology was obtained in all patients . Results Patients with gastric cancer ( n = 371 ) underwent R0 resection and staging laparoscopy with peritoneal washings ; 24 patients ( 6.5 % ) had positive peritoneal cytology . Positive cytology was associated with advanced T stage ( P = 0.02 ) but not with nodal positivity ( P = 0.11 ) . Median survival of patients with positive cytology was 14.8 months vs. 98.5 months for patients with negative cytology ( P < 0.001 ) . Multivariate analysis identified preoperative T stage , preoperative N stage , site , and cytology as significant predictors of outcome . Positive cytology was the preoperative factor most predictive of death from gastric cancer ( RR 2.7 , P < 0.001 ) . Conclusions Positive cytology is information potentially available preoperatively that identifies a patient population at very high risk for early recurrence and death after curative resection of gastric cancer Peritoneal recurrence is the foremost pattern of failure after potentially curative resection for gastric cancer . Our aim was to evaluate the prognostic value of intraperitoneal free cancer cells ( IFCCs ) in peritoneal lavage of patients who underwent potentially curative resection for gastric carcinoma . Two hundred twenty patients with gastric cancer stage I , II , or III were prospect ively evaluated with peritoneal lavage and cytologic examination . Aspirated fluid from the abdominal cavity was centrifuged and subjected to Papanicolaou staining .  The mean age was 60.9 years ( range , 21–89 years ) , and 63.6 % were men . IFCCs were detected in 6.8 % of the patients ; suspicious in 2.7 % , and negative in 84.5 % . No judgment could be given in 5.9 % of the cases . Invasion of the gastric serosa ( pT3 ) was observed in all positive cytology patients . Patients with IFCCs had a mean survival time of 10.5 months , while those with negative IFCC had a mean survival time of 61 months ( P = 0.00001 ) . There was no correlation between the presence of IFCCs and tumor size , histology , pN , or tumor site . Our conclusions are that ( 1 ) positive cytology indicates a poor prognosis in patients who underwent potentially curative gastric resection  and ( 2 ) peritoneal lavage cytology improves staging in assessing these patients and may alter their therapeutic approach PURPOSE : We evaluated the incidence and prognostic relevance of microscopic intraperitoneal tumor cell dissemination of colon cancer in comparison with dissemination of gastric cancer as a rational for additive intraperitoneal therapy . METHODS : Peritoneal washouts of 90 patients with colon and 111 patients with gastric cancer were investigated prospect ively . Sixty patients with benign diseases and 8 patients with histologically proven gross visible peritoneal carcinomatosis served as controls . Intraoperatively , 100 ml of warm NaCl 0.9 percent were instilled and 20 ml were reaspirated . In all patients hematoxylin and eosin staining ( conventional cytology ) was performed . Additionally , in 36 patients with colon cancer and 47 patients with gastric cancer , immunostaining with the HEA-125 antibody ( immunocytology ) was prepared . The results of cytology were assessed for an association with TNM category and cancer grade , based on all patients , and with patient survival , among the R0 resected patients . RESULTS : In conventional cytology 35.5 percent ( 32/90 ) of patients with colon cancer and 42.3 percent ( 47/111 ) of patients with gastric cancer had a positive cytology . In immunocytology 47.2 percent ( 17/36 ) of patients with colon cancer and 46.8 percent ( 22/47 ) of patients with gastric cancer were positive . In colon cancer , positive conventional cytology was associated with pT and M category ( P=0.044 and P=0.0002 ) , whereas immunocytology was only associated with M category ( P=0.007 ) . No association was found between nodal status and immunocytology in colon cancer and with the grading . There was a statistically significant correlation between pT M category and conventional and immunocytology in gastric cancer ( P<0.0015/P=0.007 and P<0.001/P=0.009 , respectively ) . Positive immunocytology was additionally associated with pN category ( P=0.05 ) . In a univariate analysis of R0 resected patients ( no residual tumor ) , positive immunocytology was significantly related to an unfavorable prognosis in patients with gastric cancer only ( n=30 ) . Mean survival time was significantly increased in patients with gastric cancer with negative cytology compared with positive cytology ( 1,205 ( st and ard error of the mean , 91)vs . 771 ( st and ard error of the mean , 147 ) days;P=0.007 ) but not in patients with colon cancer ( 1,215 ( st and ard error of the mean , 95)vs . 1,346 ( st and ard error of the mean , 106 ) days;P=0.55 ) . CONCLUSIONS : Because microscopic peritoneal dissemination influences survival time after R0 resections only in patients with gastric but not with colon cancer , our results may provide a basis for a decision on additive , prophylactic ( intraperitoneal ) therapy in gastric but not colon cancer BACKGROUND Radical gastrectomy with systematic lymphadenectomy ( RG ) remains controversial in the treatment of gastric carcinoma . On the other h and , the prognosis of gastric carcinoma , in the presence of intraperitoneal free cancer cells , is poor . The optimal surgical strategy for serosa-involved gastric carcinoma with intraperitoneal free cancer cells remains undefined . STUDY DESIGN A prospect i ve study of intraperitoneal cytologic washing was conducted on 134 patients with potentially curable serosa-involved gastric carcinoma who underwent RG .  During the same period , 28 patients with resectable tumors who received palliative simple gastrectomies because of the presence of gross incurable conditions ( eg , multiple hepatic metastases , peritoneal carcinomatosis , or extra-abdominal metastasis ) were used as controls . RESULTS Intraperitoneal free cancer cells were found in 26 patients ( 19.4 percent ) . Compared with the remaining 108 patients without free cancer cells , there were no significant differences in the clinicopathologic characteristics and pathologic stages . No patients died after palliative resection , but five patients died after RG . The patients with free intraperitoneal free cancer cells had a poorer long-term prognosis after RG than those without free cancer cells ( p < 0.0001 ) . The prognosis for such patients was similar to the prognosis of those who underwent palliative resection . CONCLUSIONS A peritoneal washing cytologic examination is m and atory before resection for potentially curable serosa-involved gastric carcinoma . When free cancer cells appear in the washing fluid , the cancer is incurable . Simply gastrectomy without additional lymphadenectomy is the optimal strategy for treatment PURPOSE To confirm the findings from uncontrolled studies that aggressive cytoreduction in combination with hyperthermic intraperitoneal chemotherapy ( HIPEC ) is superior to st and ard treatment in patients with peritoneal carcinomatosis of colorectal cancer origin . PATIENTS AND METHODS Between February 1998 and August 2001 , 105 patients were r and omly assigned to receive either st and ard treatment consisting of systemic chemotherapy ( fluorouracil-leucovorin ) with or without palliative surgery , or experimental therapy consisting of aggressive cytoreduction with HIPEC , followed by the same systemic chemotherapy regime . The primary end point was survival . RESULTS After a median follow-up period of 21.6 months , the median survival was 12.6 months in the st and ard therapy arm and 22.3 months in the experimental therapy arm ( log-rank test , P = .032 ) . The treatment-related mortality in the aggressive therapy group was 8 % . Most complications from HIPEC were related to bowel leakage . Subgroup analysis of the HIPEC group showed that patients with 0 to 5 of the 7 regions of the abdominal cavity involved by tumor at the time of the cytoreduction had a significantly better survival than patients with 6 or 7 affected regions ( log-rank test , P < .0001 ) . If the cytoreduction was macroscopically complete ( R-1 ) , the median survival was also significantly better than in patients with limited ( R-2a ) , or extensive residual disease ( R-2b ; log-rank test , P < .0001 ) . CONCLUSION Cytoreduction followed by HIPEC improves survival in patients with peritoneal carcinomatosis of colorectal origin . However , patients with involvement of six or more regions of the abdominal cavity , or grossly incomplete cytoreduction , had still a grave prognosis The poor prognosis of patients with gastric cancer with free abdominal tumour cells on cytological examination has been described in Japan . In a r and omized trial in the Netherl and s comparing D1 and D2 lymphadenectomy for gastric cancer , patients were subjected to cytological examination of abdominal washings on an optional basis ; findings were of no consequence for scheduled treatment . Cytology results in 535 patients were obtained , in 457 ( 85·4 per cent ) after curative resection and in 78 ( 14·6 per cent ) after palliative operation . There was a clear association of positive cytology results with serosal invasion ( 12 per cent positive cytology ) and lymph node infiltration ( 7·5 per cent positive cytology ) . Survival of those with positive cytology results was significantly lower than that of those with negative findings , irrespective of the procedure employed ( curative or palliative ) . Cytological examination of abdominal washings increases the accuracy of staging and improves the selection of patients suitable for curative or palliative resection BACKGROUND Peritoneal dissemination is frequently found during laparotomy in patients with serosa-invading gastric cancer . Detection of exfoliated cancer cells in abdominal lavage cytology is indicative of stage IV because of its strong association with peritoneal dissemination . Herein we have described peritoneal lavage cytology using a bedside procedure under local anesthesia . METHODS A prospect i ve study of 113 patients with serosa-invading gastric cancer but without peritoneal metastases was performed . A drainage tube was inserted into the abdominal cavity for peritoneal lavage .  Patients with negative cytology ( CY0 ) were scheduled for curative gastrectomy .  RESULTS The bedside procedure was performed safely without any complications .  Lavage cytology  identified CY1 in 35 ( 31.0 % ) patients and CY0 in 78 ( 69.0 % ) patients . Patients with CY0 underwent  laparotomy  and  peritoneal lavage cytology  , and 9 were found to have peritoneal disease ( 3 with operative CY1 , 4 with peritoneal dissemination , and 2 with both operative CY1 and peritoneal dissemination ) . Two other patients had small , distant metastases . Finally , curative gastrectomy was achieved in 67 ( 59.3 % ) patients , but not in 46 ( 40.7 % ) patients . Thus , our bedside , pre-operative peritoneal lavage detected 76.1 % ( 35/46 ) of noncurative disease before operative with a false-negative rate for detecting peritoneal disease of 20.5 % ( 9/44 ) . Patients with pre-operative CY1 had a poorer prognosis than pre-operative CY0 ( 2-year cause-specific survival 26.6 % vs 82.6 % ) . CONCLUSION Pre-operative bedside peritoneal lavage under local anesthesia followed by cytology is a simple and safe method for the pre-operative diagnosis of peritoneal dissemination and may help to reduce unexpected , noncurative surgery PURPOSE We have developed a novel molecular method of diagnosis using the technique of transcriptase-reverse transcriptase concerted reaction ( TRC ) for the detection of cancer micrometastasis . This study prospect ively examined the clinical importance of the TRC diagnosis with peritoneal lavage fluids collected from gastric cancer operations at multiple institutes . METHODS TRC amplification targeting carcinoembryonic antigen mRNA was applied to detect gastric cancer cells in peritoneal lavage fluids obtained during gastric cancer resections from nine different hospitals . A total of 137 patients with a clinical diagnosis of serosa-invading neoplasms were enrolled to investigate the correlation between the TRC diagnosis and patient prognosis . RESULTS Of the 137 patients , 27 ( 20 % ) were positive by cytologic examination . In contrast , TRC targeting carcinoembryonic antigen mRNA was positive in 59 of 137 ( 54 % ) patients . TRC positivity was associated with a poorer overall survival in all patients and in the 104 patients who underwent a curative operation . TRC positivity also was associated with the peritoneal recurrence-free survival rate in the 104 curative cases . Multivariate analysis showed that TRC positivity and the pathologic N factor were prognostic factors for the overall survival time . CONCLUSION Our prospect i ve multicenter study showed that the TRC test using peritoneal lavage fluids could be a potential prognostic factor to predict patient survival and peritoneal recurrence with clinical ly diagnosed , serosa-invading gastric cancer Background Peritoneal lavage cytology has been included as part of the staging process in the 13th edition of the Japanese Classification of Gastric Cancer . However , this procedure has neither been studied nor established in our population . We aim ed to evaluate its prognostic relevance among our patients with gastric cancer . Methods A total of 142 consecutive patients with gastric carcinoma were recruited prospect ively . All had histologically proven gastric carcinomas and had undergone laparotomy and intraoperative peritoneal lavage for cytological examination at Singapore General Hospital . The fluid recovered was centrifuged and stained by the Papanicolau method . All patients were followed up with endpoints of cancer recur-rence and mortality . Results There were 91 men and 51 women ; 36 patients ( 25.4 % ) had positive peritoneal lavage . Patients with advanced macroscopic features , presence of vascular invasion , nodal involvement , advanced depth of tumor invasion and metastatic disease tended to have positive lavage , by univariate logistic regression analysis . Despite curative resections , patients with positive cytology had a more dismal disease-free survival ( mean , 27 months vs 53 months ; P < 0.0001 by log rank test ) and higher recurrence rate ( 54.5 % vs 19.3 % ; P = 0.007 by log rank test ) . There was also a trend towards earlier recurrences ( median , 8 months vs 11 months ; P = 0.37 ) . By multivariate Cox regression stepwise analysis , advanced depth of tumor invasion and positive lavage cytology were found to be independent poor prognostic factors for disease-free survival . Conclusion Positive peritoneal lavage cytology  correlated well with advanced features of gastric cancer . It is an independent poor prognostic factor and the procedure should be routinely performed . Integration of lavage status into our current staging systems may serve as a guide for adjuvant therapeutic options to improve the survival of gastric cancer in our population BACKGROUND A regimen of epirubicin , cisplatin , and infused fluorouracil ( ECF ) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma . We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer . METHODS We r and omly assigned patients with resectable adenocarcinoma of the stomach , esophagogastric junction , or lower esophagus to either perioperative chemotherapy and surgery ( 250 patients ) or surgery alone ( 253 patients ) . Chemotherapy consisted of three preoperative and three postoperative cycles of intravenous epirubicin ( 50 mg per square meter of body-surface area ) and cisplatin ( 60 mg per square meter ) on day 1 , and a continuous intravenous infusion of fluorouracil ( 200 mg per square meter per day ) for 21 days . The primary end point was overall survival . RESULTS  ECF-related adverse effects were similar to those previously reported among patients with advanced gastric cancer .  Rates of postoperative complications were similar in the perioperative-chemotherapy group and the surgery group ( 46 percent and 45 percent , respectively ) , as were the numbers of deaths within 30 days after surgery . The resected tumors were significantly smaller and less advanced in the perioperative-chemotherapy group . With a median follow-up of four years , 149 patients in the perioperative-chemotherapy group and 170 in the surgery group had died . As compared with the surgery group , the perioperative-chemotherapy group had a higher likelihood of overall survival ( hazard ratio for death , 0.75 ; 95 percent confidence interval , 0.60 to 0.93 ; P=0.009 ; five-year survival rate , 36 percent vs. 23 percent ) and of progression-free survival ( hazard ratio for progression , 0.66 ; 95 percent confidence interval , 0.53 to 0.81 ; P<0.001 ) . CONCLUSIONS In patients with operable gastric or lower esophageal adenocarcinomas , a perioperative regimen of ECF decreased tumor size and stage and significantly improved progression-free and overall survival . ( Current Controlled Trials number , IS RCT N93793971 [ controlled-trials.com ] . ) Objective : This prospect i ve r and omized multicenter study aims to evaluate the efficacy of extensive intraoperative peritoneal lavage followed by intraperitoneal chemotherapy ( EIPL-IPC ) on the overall 5-year survival of advanced gastric cancer patients with intraperitoneal free cancer cells without overt peritoneal metastasis ( CY+/P− ) . The study also aims to determine the merit and reliability of EIPL-IPC therapy as a prophylactic strategy for peritoneal metastasis . Summary Background Data : Although the prognosis of advanced gastric cancer patients with CY+/P− is extremely poor , a suitable st and ard regimen for treating such patients has not yet been established . Methods : A total of 88 patients with CY+/P− from 1522 patients with advanced gastric cancer at multicenters were enrolled in this study and were r and omly allocated to 3 groups : surgery alone group , surgery plus intraperitoneal chemotherapy ( IPC ) group , and surgery plus EIPL and IPC ( EIPL-IPC ) group . Prognostic significance of EIPL-IPC therapy was evaluated by Kaplan-Meier curves , and its value as an independent prognostic factor was assessed by univariate and multivariate analyses . Results : The overall 5-year survival rate of the patients with EIPL-IPC was 43.8 % , and this data were significantly better than that of the IPC group ( 4.6 % , P < 0.0001 ) and the surgery alone group ( 0 % , P < 0.0001 ) . Among various recurrent patterns , the EIPL-IPC group had a significantly lower incidence of peritoneal recurrence than both of the other groups ( P < 0.0001 ) . Univariate and multivariate analyses revealed that EIPL was the most significant impact factor . Conclusions : The present study clearly revealed that EIPL-IPC therapy significantly improved the 5-year survival span of advanced gastric cancer patients with CY+/P−.  Thus , EIPL-IPC therapy is strongly recommended as a st and ard prophylactic strategy for peritoneal dissemination BACKGROUND AND OBJECTIVES Free cancer cells in the abdominal cavity exfoliated from a tumor are considered to be responsible for peritoneal dissemination , the most frequent pattern of failure in gastric carcinoma patients treated with curative surgery . METHODS A prospect i ve survival analysis was performed with 91 gastric carcinoma patients treated by potentially curative resection . Cytology was performed for all the patients . The method of Kaplan and Meier was used to construct curves with diagnosis of peritoneal dissemination and cancer death as the end points . Multivariate analysis by Cox 's proportional hazards model was performed to identify independent prognostic factors of significance . RESULTS Patients with a positive cytology result were confirmed to have a greater risk for recurrence in the pattern of peritoneal carcinomatosis and hence a significantly inferior prognosis . Positive cytology was the only significant independent prognostic factor among the curatively resected patients with advanced gastric carcinoma . CONCLUSIONS Peritoneal lavage cytology should be employed for all advanced cancer undergoing potentially curative resection for added accuracy in the stage classification . The results should also reflect the eligibility of the patients for future clinical trials involving perioperative intraperitoneal chemotherapy PURPOSE To compare the long-term survival of patients with isolated and resectable peritoneal carcinomatosis ( PC ) in comparable groups of patients treated with systemic chemotherapy containing oxaliplatin or irinotecan or by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) . PATIENTS AND METHODS All patients with gross PC from colorectal adenocarcinoma who had undergone cytoreductive surgery plus HIPEC from 1998 to 2003 were evaluated . The st and ard group was constituted by selecting patients with colorectal PC treated with palliative chemotherapy during the same period , but who had not benefited from HIPEC because the technique was unavailable in the center at that time . RESULTS Forty-eight patients were retrospectively included in the st and ard group and were compared with 48 patients who had undergone HIPEC  and were evaluated prospect ively . All characteristics were comparable except age and tumor differentiation . There was no difference in systemic chemotherapy , with a mean of 2.3 lines per patient . Median follow-up was 95.7 months in the st and ard group versus 63 months in the HIPEC group . Two-year and 5-year overall survival rates were 81 % and 51 % for the HIPEC group , respectively , and 65 % and 13 % for the st and ard group , respectively . Median survival was 23.9 months in the st and ard group versus 62.7 months in the HIPEC group ( P < .05 , log-rank test ) . CONCLUSION Patients with isolated , resectable PC achieve a median survival of 24 months with modern chemotherapies , but only surgical cytoreduction plus HIPEC is able to prolong median survival to roughly 63 months , with a 5-year survival rate of 51 %
PURPOSE Despite continuously improving therapies , gastric cancer still shows poor survival in locally advanced stages with local recurrence rates of up to 50 % and peritoneal recurrence rates of 17 % after curative surgery .
We performed a systematic review with meta-analyses to clarify whether positive intraperitoneal cytology ( IPC ) indicates a high risk of disease recurrence and poor overall survival in gastric cancer .