Cytology of peritoneal lavage performed during staging laparoscopy for gastrointestinal malignancies: Is it useful?

Objective To evaluate the potential benefit of cytology of the peritoneal ravage obta ined during diagnostic laparoscopy for staging gastrointestinal (Gl) malign ancies. Summary Background Data Peritoneal lavage is a simple procedure that can be performed during laparo tomy for Gl tumors. Tumor cells in the lavage fluid are thought to indicate intraperitoneal tumor seeding and to have a negative effect on survival. F or this reason, peritoneal ravage is frequently added to diagnostic laparos copy for staging Gl malignancies. Methods Patients who underwent peritoneal lavage during laparoscopic staging for Gl malignancies between June 1992 and September 1997 were included. Lavage fl uids were stained using Giemsa and Papanicolaou methods. Cytology results w ere correlated with the presence of metastases and tumor ingrowth found dur ing laparoscopy and with survival. Results Cytology of peritoneal lavage was performed in 449 patients. Tumor cells we re found in 28 patients (6%): 8/87 with an esophageal tumor. 2/32 With live r metastases, 11/72 With a proximal bile duct tumor, 7/236 with a periampul lary tumor, and none in 7 and 15 patients with a primary liver tumor or pan creatic body or tail tumor, respectively. In 19 of the 28 patients (68%) in whom tumor cells were found, metastatic disease was detected during laparo scopy, and 3 of the 28 patients had a false-positive (n = 1) or a misleadin g positive (n = 2) lavage result. Therefore, ravage was beneficial in only 6/449 patients (1.3%); in these patients, the lavage result changed the ass essment of tumor stage and adequately predicted irresectable disease. Univa riate analysis showed a significant survival difference between patients in whom lavage detected tumor cells and those in whom it did not, but multiva riate analysis revealed that these survival differences were caused by meta static or ingrowing disease. Conclusion Cytology of peritoneal lavage with conventional staining should no longer b e performed during laparoscopic staging of Gl malignancies because it provi des an additional benefit in only 1.3% of patients and has limited prognost ic value for survival in this group of patients.