Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2009

01-12-2009 | Pancreatic Tumors

Prognostic Impact of RT-PCR-Based Detection of Peritoneal Micrometastases in Patients with Pancreatic Cancer Undergoing Curative Resection

Authors: Kaitlyn J. Kelly, MD, Joyce Wong, MD, Rebecca Gladdy, MD, PhD, Kimberly Moore-Dalal, MD, Yanghee Woo, MD, Mithat Gonen, PhD, Murray Brennan, MD, FACS, Peter Allen, MD, Yuman Fong, MD, Daniel Coit, MD, FACS

Published in: Annals of Surgical Oncology | Issue 12/2009

Login to get access

Abstract

Background

Positive peritoneal fluid cytology predicts poor outcome in patients with resected pancreatic cancer. Reverse transcription–polymerase chain reaction (RT-PCR) has been proposed as a more sensitive means of detection of peritoneal micrometastases than conventional cytology. The clinical significance of RT-PCR positivity in the absence of other evidence of peritoneal disease is unknown. The purpose of the current study was to determine the outcome RT-PCR positive/cytology-negative patients who underwent potentially curative resection.

Methods

Peritoneal washings were collected prospectively from 115 patients with pancreatic cancer undergoing diagnostic laparoscopy at a single institution. Specimens were analyzed by a cytopathologist and by RT-PCR for carcinoembryonic antigen (CEA).

Results

Of the 115 patients, 62 (54%) underwent R0 resection. Eleven of the 62 patients (18%) had peritoneal washings that were negative by conventional cytology but positive for CEA by RT-PCR. Those 11 patients experienced early peritoneal and overall disease recurrence versus those who were RT-PCR negative (P = 0.001, P = 0.003, respectively) independent of nodal status.

Conclusions

RT-PCR for CEA is a sensitive and specific method for the detection of clinically significant peritoneal micrometastases from pancreatic cancer and it might identify a subgroup of patients with otherwise negative findings at staging laparoscopy who might respond better to treatment other than primary surgical resection.
Literature
1.
House MG, Fong Y, Arnaoutakis DJ, et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg. 2008;12(2):270–8.CrossRefPubMed
2.
Williams TK, Rosato EL, Kennedy EP, et al. Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg. 2009;208(2):210–7.CrossRefPubMed
3.
Bentrem DJ, Brennan MF. Outcomes in oncologic surgery: does volume make a difference? World J Surg. 2005;29(10):1210–6.CrossRefPubMed
4.
Mayo SC, Austin DF, Sheppard BC, et al. Evolving preoperative evaluation of patients with pancreatic cancer: does laparoscopy have a role in the current era? J Am Coll Surg. 2009;208(1):87–95.CrossRefPubMed
5.
Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol. 2004;99(3):492–501.CrossRefPubMed
6.
Howard TJ, Chin AC, Streib EW, et al. Value of helical computed tomography, angiography, and endoscopic ultrasound in determining resectability of periampullary carcinoma. Am J Surg. 1997;174(3):237–41.CrossRefPubMed
7.
White R, Winston C, Gonen M, et al. Current utility of staging laparoscopy for pancreatic and peripancreatic neoplasms. J Am Coll Surg. 2008;206(3):445–50.CrossRefPubMed
8.
Tani M, Kawai M, Miyazawa M, et al. Liver metastasis as an initial recurrence has no impact on the survival of patients with resectable pancreatic adenocarcinoma. Langenbecks Arch Surg. 2009;394(2):249–53.CrossRefPubMed
9.
Jimenez RE, Warshaw AL, Fernandez-Del Castillo C. Laparoscopy and peritoneal cytology in the staging of pancreatic cancer. J Hepatobiliary Pancreat Surg. 2000;7(1):15–20.CrossRefPubMed
10.
Ferrone CR, Haas B, Tang L, et al. The influence of positive peritoneal cytology on survival in patients with pancreatic adenocarcinoma. J Gastrointest Surg. 2006;10(10):1347–53.CrossRefPubMed
11.
Yachida S, Fukushima N, Sakamoto M, et al. Implications of peritoneal washing cytology in patients with potentially resectable pancreatic cancer. Br J Surg. 2002;89(5):573–8.CrossRefPubMed
12.
Merchant NB, Conlon KC, Saigo P, et al. Positive peritoneal cytology predicts unresectability of pancreatic adenocarcinoma. J Am Coll Surg. 1999;188(4):421–6.CrossRefPubMed
13.
Greene FL. AJCC cancer staging manual. 6th ed.
14.
Katsuragi K, Yashiro M, Sawada T, et al. Prognostic impact of PCR-based identification of isolated tumour cells in the peritoneal lavage fluid of gastric cancer patients who underwent a curative R0 resection. Br J Cancer. 2007;97(4):550–6.CrossRefPubMed
15.
Dalal KM, Woo Y, Kelly K, et al. Detection of micrometastases in peritoneal washings of gastric cancer patients by the reverse transcriptase polymerase chain reaction. Gastric Cancer. 2008;11(4):206–13.CrossRefPubMed
16.
Mori K, Aoyagi K, Ueda T, et al. Highly specific marker genes for detecting minimal gastric cancer cells in cytology negative peritoneal washings. Biochem Biophys Res Commun. 2004;313(4):931–7.CrossRefPubMed
17.
Reis-Filho JS, de Lander Schmitt FC. Fluorescence in situ hybridization, comparative genomic hybridization, and other molecular biology techniques in the analysis of effusions. Diagn Cytopathol. 2005;33(5):294–9.CrossRefPubMed
18.
Dalal KM, Woo Y, Galanis C, et al. Detection of micrometastases in peritoneal washings of pancreatic cancer patients by the reverse transcriptase polymerase chain reaction. J Gastrointest Surg. 2007;11(12):1598–606.CrossRefPubMed
19.
Shah D, Fisher WE, Hodges SE, et al. Preoperative prediction of complete resection in pancreatic cancer. J Surg Res. 2008;147(2):216–20.CrossRefPubMed
20.
Ahmed SI, Bochkarev V, Oleynikov D, Sasson AR. Patients with pancreatic adenocarcinoma benefit from staging laparoscopy. J Laparoendosc Adv Surg Tech A. 2006;16(5):458–63.CrossRefPubMed
21.
Yonemura Y, Endou Y, Fujimura T, et al. Diagnostic value of preoperative RT-PCR-based screening method to detect carcinoembryonic antigen-expressing free cancer cells in the peritoneal cavity from patients with gastric cancer. ANZ J Surg. 2001;71(9):521–8.CrossRefPubMed
22.
Nishiyama M, Takashima I, Tanaka T, et al. Carcinoembryonic antigen levels in the peritoneal cavity: useful guide to peritoneal recurrence and prognosis for gastric cancer. World J Surg. 1995;19(1):133–7.CrossRefPubMed
Metadata
Title
Prognostic Impact of RT-PCR-Based Detection of Peritoneal Micrometastases in Patients with Pancreatic Cancer Undergoing Curative Resection
Authors
Kaitlyn J. Kelly, MD
Joyce Wong, MD
Rebecca Gladdy, MD, PhD
Kimberly Moore-Dalal, MD
Yanghee Woo, MD
Mithat Gonen, PhD
Murray Brennan, MD, FACS
Peter Allen, MD
Yuman Fong, MD
Daniel Coit, MD, FACS
Publication date
01-12-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0683-2

Other articles of this Issue 12/2009

Annals of Surgical Oncology 12/2009 Go to the issue

Gastrointestinal Oncology

Better 5-Year Survival Rate Following Curative Gastrectomy in Overweight Patients

Hepatobiliary and Pancreatic Tumors

Surgical Resection Versus Laparoscopic Radiofrequency Ablation in Patients With Hepatocellular Carcinoma and Child-Pugh Class A Liver Cirrhosis

Thoracic Oncology

CD98 Expression Is Associated with Poor Prognosis in Resected Non-Small-Cell Lung Cancer with Lymph Node Metastases

Breast Oncology

Prognostic Factors in 77 Curative Chest Wall Resections for Isolated Breast Cancer Recurrence

Breast Oncology

Can Axillary Lymph Node Dissection Be Safely Omitted for Early-Stage Breast Cancer Patients with Sentinel Lymph Node Micrometastasis?

Melanomas

S-100B Concentrations Predict Disease-Free Survival in Stage III Melanoma Patients