Cytological Analysis of Peritoneal Washings: Now Part of the Standard Preoperative Staging Evaluation for Patients With Resectable Gastric Cancer?

Excerpt

The optimal treatment of gastric adenocarcinoma continues to be a challenging clinical problem. Resection alone is associated with a high rate of relapse and a 10-year survival rate ranging between 3% and 42%, depending on stage.1 As a result of the generally poor outcomes after operative therapy, several authors have focused their efforts on more accurate preoperative staging and on the identification of preoperatively recognizable factors that may predict either better or worse survival. The goal of these studies is to select the most appropriate therapy for patients with gastric cancer according to their stage of disease and relative risk of death from malignancy. Consequently, for patients expected to have a poorer prognosis after curative resection alone, gastrectomy with aggressive multimodal therapies combining neoadjuvant or adjuvant strategies may offer better outcomes. For patients treated with preoperative chemotherapy protocols, an additional advantage is gained in which resection may be used selectively for patients most likely to benefit from an operation, while laparotomy is avoided in patients who exhibit progressive disease due to a more biologically aggressive cancer. …