Peritoneal washings are not predictive of occult peritoneal disease in patients with hilar cholangiocarcinoma

BACKGROUND: Evaluation of peritoneal cytology provides valuable staging inf ormation in patients with gastric and pancreatic adenocarcinoma, but its us efulness in patients with extrahepatic cholangiocarcinoma is unclear. The a im of this study was to evaluate the predictive value of peritoneal cytolog y in patients with potentially resectable hilar cholangiocarcinoma. This st udy evaluated a possible association between positive peritoneal cytology a nd percutaneous transhepatic biliary drainage, which is commonly used in th ese patients and may result in peritoneal biliary leakage and peritoneal se eding. STUDY DESIGN: From October 1997 through June 2000 26 patients with hilar ch olangiocarcinoma underwent staging laparoscopy immediately before planned o pen exploration and resection. Peritoneal washings were obtained during lap aroscopic examination before any biopsies were taken. Cytologic analysis wa s performed using the Papanicolau technique. RESULTS: There were 18 men and 8 women, with a median age of 69 years (rang e 42 to 81 years). The most common presenting symptom was jaundice (n = 19) . Previous biliary drainage was performed in 23 patients: 9 percutaneous an d 14 endoscopic. Metastatic disease was suspected preoperatively in six pat ients, three to the liver, two to the peritoneum, and one to regional lymph nodes, all of which were confirmed at laparoscopy, Laparoscopy identified five additional patients with metastatic disease. Peritoneal cytology was p ositive for malignant cells in two patients, both of whom had gross periton eal metastases. Nine other patients had metastatic disease to distant sites within the abdomen, but none had positive cytology. Overall, six patients had metastatic disease to the peritoneal cavity, only one of whom had under gone earlier percutaneous biliary drainage. CONCLUSIONS: Peritoneal cytology was not predictive of occult metastatic di sease. Laparoscopic staging identified some patients with unresectable hila r cholangiocarcinoma, but analysis of peritoneal cytology provided no addit ional information. There was no association between percutaneous transhepat ic biliary drainage and peritoneal tumor seeding. (J Am Coll Surg 2001;193: 620-625. (C) 2001 by the American College of Surgeons).