Borrmann type IV gastric carcinoma a surgical disease? An old problem revisited with reference to the result of peritoneal washing cytology

Background and Objectives: Borrmann type IV gastric carcinoma (B-4) remains a disease with poor prognosis despite an aggressive surgical approach. Cyt ology examination of the peritoneal washes is an established prognostic fac tor for gastric carcinoma in general, and may be useful for identifying ade quate treatment strategy for B-4. Methods: Pathologic data from 70 patients with B-4 who underwent laparotomy and peritoneal washing cytology during the recent 6 years were retrieved f rom a prospective computer database and reviewed. Prognostic significance o f the cytology examination along with other known clinicopathologic variabl es was evaluated by univariate and multivariate analyses. Results: Long-term survivors were observed only among the patients who were treated with curative RO resection. Prognosis of the patients with positiv e cytology and no other residual disease (R1) was extremely poor and was eq uivalent to that of the patients undergoing noncurative R2 resection. No di fference in survival, either, was observed between the patients treated by R2 resection and those who did not undergo resection. Multivariate analysis identified cytology examination as an independent prognostic factor. Conclusions: Peritoneal washing cytology plays an important role in staging B4. Positive cytology findings as well as other evidence of disseminated d isease may indicate that gastrectomy should be avoided. (C) 2001 Wiley-Liss , Inc.