Prognostic value of positive pleural lavage in patients with lung cancer resection

Background. Despite an early stage, lung cancer patients often have a poor survival, suggesting inaccurate staging. A pleural lavage demonstrating mal ignant cells at the time of operation may predict a poorer survival, partic ularly in patients with otherwise early disease. Methods. Patients, with no preoperative evidence of pleural effusions and u ndergoing a surgical resection with curative intent, had a preresectional a nd postresectional lavage to be evaluated by cytology. Results. Fourteen percent of patients with stage I disease had malignant ce lls in their preresectional lavage and had a significantly shorter survival than stage I patients with a negative lavage. Positivity of preresectional lavage was not correlated with nodal status, pleural or lymphatic involvem ent, or histologic findings. Conclusions. Preoperative pleural lavage should become a standard technique intraoperatively to better characterize and stage patients undergoing lung cancer resections. Patients with malignant cells in their preoperative lav age should be upstaged. (Ann Thorac Surg 1999;67:1435-9) (C) 1999 by The So ciety of Thoracic Surgeons.