OPTIMAL SURGICAL STRATEGY FOR POTENTIALLY CURABLE SEROSA-INVOLVED GASTRIC-CARCINOMA WITH INTRAPERITONEAL FREE CANCER-CELLS

BACKGROUND: Radical gastrectomy with systematic lymphadenectomy (RG) r emains controversial in the treatment of gastric carcinoma. On the oth er hand, the prognosis of gastric carcinoma, in the presence of intrap eritoneal free cancer cells, is poor. The optimal surgical strategy fo r serosa-involved gastric carcinoma with intraperitoneal free cancer c ells remains undefined. STUDY DESIGN: A prospective study of intraperi toneal cytologic washing was conducted on 134 patients with potentiall y curable serosa-involved gastric carcinoma who underwent RG. During t he same period, 28 patients with resectable tumors who received pallia tive simple gastrectomies because of the presence of gross incurable c onditions (eg, multiple hepatic metastases, peritoneal carcinomatosis, or extra-abdominal metastasis) were used as controls. RESULTS: Intrap eritoneal free cancer cells were found in 26 patients (19.4 percent). Compared with the remaining 108 patients without free cancer cells, th ere were no significant differences in the clinicopathologic character istics and pathologic stages. No patients died after palliative resect ion, but five patients died after RG. The patients with free intraperi toneal free cancer cells had a poorer long-term prognosis after RG tha n those without free cancer cells (p<0.0001). The prognosis for such p atients was similar to the prognosis of those who underwent palliative resection. CONCLUSIONS: A peritoneal washing cytologic examination is mandatory before resection for potentially curable serosa-involved ga stric carcinoma. When free cancer cells appear in the washing fluid, t he cancer is incurable. Simple gastrectomy without additional lymphade nectomy is the optimal strategy for treatment.