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  • Title: Is peritoneal cytology a predictor of unresectability in pancreatic carcinoma?
    Author: Schmidt J, Fraunhofer S, Fleisch M, Zirngibl H.
    Journal: Hepatogastroenterology; 2004; 51(60):1827-31. PubMed ID: 15532836.
    Abstract:
    BACKGROUND/AIMS: Demonstration of unresectability often requires diagnostic laparotomy with high co-morbidity in pancreatic carcinoma. The value of detected peritoneal tumor cells and influence on outcome should be determined. METHODOLOGY: In a prospective study 150 consecutive patients with pancreatic carcinoma were evaluated. Improvement of diagnostic accuracy in diagnosing unresectability was calculated for combination of CT, endoscopic ultrasonography and peritoneal cytology. RESULTS: Unexpected subglissonian metastases were found in 10%. 87 patients with peritoneal washings were included in the study, 20 patients with detected peritoneal tumor cells (n=22) were inoperable. In all patients of this group the ventral integrity of pancreas was damaged. In 23 patients with preoperative existent ascites, only in 4 cases could peritoneal tumor cells be detected. In patients with positive cytology together with disrupted ventral pancreatic margin as predictors of unresectability, sensitivity was 100% and specificity 96%. CONCLUSIONS: Addition of diagnostic laparoscopy combined with peritoneal cytology and minimally invasive palliation procedures (endoscopic biliary prosthesis, laparoscopic gastrojejunostomy) to the staging-protocol for pancreatic carcinoma may decrease operative lethality and unnecessary laparotomies may be avoided safely. As unexpected subglissonian micrometastases may additionally be present in 5-10%, perioperative laparoscopy is always advisable.
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