VALUE OF PERITONEAL-LAVAGE CYTOLOGY DURING LAPAROSCOPIC STAGING OF PATIENTS WITH GASTRIC-CARCINOMA

Forty-nine consecutive patients with advanced gastric carcinoma underw ent preoperative staging by laparoscopy between June 1991 and June 199 2. Peritoneal lavage with cytologic examination was performed when asc ites was not present. In eight cases (16.3%), laparoscopy revealed car cinomatosis and/or multiple hepatic metastases, so laparotomy was not performed. Intraperitoneal free cancer cells (IFCCs) were detected in 41% of patients (65% in patients with ascites and 28% by peritoneal la vage). In the absence of macroscopic peritoneal dissemination, IFCCs w ere encountered in 29% of patients. IFCCs were present only when invas ion of the gastric serosa was >3 cm(2) or when adjacent organs and str uctures were already invaded. Mucinous adenocarcinoma, Borrmann class TV tumors, and Stage IV patients had higher incidence of IFCCs. Cytolo gic results were similar at laparoscopy and laparotomy (p > 0.05). The refore, cytologic evaluation of peritoneal lavage added sensitivity to laparoscopy in assessing patients with advanced gastric carcinoma and may alter their therapeutic approach.