Does pleural lavage cytology before thoracic closure predict both patient's prognosis and site of cancer recurrence after resection of esophageal cancer?

Background. Operative manipulation occasionally exfoliates and spreads canc er cells in the surgical field, and it is a matter of concern whether the e xfoliated cancer cells actually affect the patient's prognosis and sites Of cancer recurrence. Methods. In 240 patients with esophageal cancers, lavage cytology (LC) of t he right pleural cavity was performed before and after esophageal resection combined with regional lymphadenectomy, The cytologic results were compare d with the pathologic factors associated with cancer extension, postoperati ve survival, and cause of surgical failure. Results. Only 3 patients (1.3%) were LC Positive before resection. Of the 2 37 LC-negative patients, LC was also negative after resection in 215 patien ts (90.7%) (LC-/-), but LC became positive after resection in 22 patients ( 9.3%) (LC-/+). The 3-year survival rate was 0% in the LC-/+ group versus 65 % in the LC-/- group, and the median survival rates were 10.9 months and 25 .0 months, respectively (P < .0001). Multivariate analysis revealed that LC -/+ was an independent prognostic factor (P = .0331), along with nodal invo lvement and depth of cancer invasion. However, there were no significant di fferences in the sites Of cancer recurrence between the 2 groups. Only 1 pa tient was found to develop the first recurrence in the pleural cavity. The LC-/+ group had a higher incidence of bulky lymph-node metastasis (P = .000 9). Conclusions. Pleural LC after resection of esophageal cancer seems to be a prognostic indicator of overall recurrence., but not necessarily in the ple ural cavity. Patients with a positive LC after resection may benefit most b y effective systemic adjuvant chemotherapy.