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. 2014 Dec;30(6):266-73.
doi: 10.3393/ac.2014.30.6.266. Epub 2014 Dec 31.

Role of peritoneal lavage cytology and prediction of prognosis and peritoneal recurrence after curative surgery for colorectal cancer

Sung Joon Bae  1 , Ui Sup Shin  1 , Young-Jun Ki  1 , Sang Sik Cho  1 , Sun Mi Moon  1 , Sun Hoo Park  2
Affiliations

Role of peritoneal lavage cytology and prediction of prognosis and peritoneal recurrence after curative surgery for colorectal cancer

Sung Joon Bae et al. Ann Coloproctol. 2014 Dec.

Abstract

Purpose: In colorectal cancer, the role of detecting free malignant cells from peritoneal lavage is currently unclear. In this study, we investigated the positive rate of free malignant cells in peritoneal lavage fluid and their predictive value for prognosis and peritoneal recurrence after a curative resection.

Methods: From October 2009 to December 2011, in a prospective manner, we performed cytologic examinations of peritoneal lavage fluid obtained just after the abdominal incision from 145 patients who underwent curative surgery for colorectal cancer. We used proportional hazard regression models to analyze the predictive role of positive cytology for peritoneal recurrence and survival.

Results: Among total 145 patients, six patients (4.1%) showed positive cytology. During the median follow-up of 32 months (range, 8-49 months), 27 patients (18.6%) developed recurrence. Among them, 5 patients (3.4%) showed peritoneal carcinomatosis. In the multivariate analysis, positive cytology was an independent predictive factor for peritoneal recurrence (hazard ratio [HR], 136.5; 95% confidence interval [CI], 12.2-1,531.9; P < 0.0001) and an independent poor prognostic factor for overall survival (HR, 11.4; 95% CI, 1.8-72.0; P = 0.009) and for disease-free survival (HR, 11.1; 95% CI, 3.4-35.8; P < 0.0001).

Conclusion: Positive cytology of peritoneal fluid was significantly associated with peritoneal recurrence and worse survival in patients undergoing curative surgery for colorectal cancer. Peritoneal cytology might be a useful tool for selecting patients who need intraperitoneal or systemic chemotherapy.

Keywords: Colorectal neoplasms; Cytology; Peritoneal metastasis; Prognosis; Survival.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
(A) The malignant cells are arranged in 3-dimensional clusters with overlapping nuclei in the background of scattered reactive mesothelial cells, neutrophils and lymphocytes (Papanicolaou staining, ×400). (B) A tumor cell with high nuclear-to-cytoplasmic ratio has a hyperchromatic and coarse nucleus with an irregular eccentric contour and is 10 times larger than lymphocytes (Papanicolaou staining, ×400).
Fig. 2
Fig. 2
Kaplan-Meier survival curves for disease-free survival according to the results of peritoneal cytology.
Fig. 3
Fig. 3
Kaplan-Meier survival curves for overall survival according to the results of peritoneal cytology.
Fig. 4
Fig. 4
Kaplan-Meier survival curves for peritoneal recurrence-free survival according to the results of peritoneal cytology.
See this image and copyright information in PMC

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