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Percutaneous Peritoneal Lavage for the Rapid Staging of Gastric and Pancreatic Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Positive peritoneal cytology is classified as M1 disease in gastric and pancreatic cancer. While peritoneal cytology is typically obtained by laparoscopic peritoneal lavage, this study sought to examine the feasibility and safety of performing this percutaneously, with monitored anesthesia care and in combination with other diagnostic procedures to condense and expedite the staging process.

Methods

Patients with gastric or pancreatic cancer scheduled for laparoscopy with peritoneal lavage were prospectively enrolled to undergo intraoperative percutaneous peritoneal lavage prior to laparoscopic peritoneal lavage. Saline was infused through a percutaneously-inserted catheter and fluid was collected for peritoneal cytology. Three-quadrant washings collected during laparoscopy were also sent for peritoneal cytology. The primary outcome was to evaluate the sensitivity and specificity of percutaneous peritoneal lavage for detecting positive peritoneal cytology compared with the gold standard of laparoscopic peritoneal lavage, while the secondary outcome was to determine safety.

Results

Percutaneous peritoneal lavage was successfully performed in 70 of 76 patients (92%). Ten of 48 gastric cancer patients (21%) and three of 22 pancreatic cancer patients (14%) had positive percutaneous and laparoscopic peritoneal cytology. Two additional gastric cancer patients had positive laparoscopic peritoneal cytology only. Sensitivity and specificity of percutaneous peritoneal lavage compared with laparoscopic peritoneal lavage were 87% and 100%, respectively. No complications occurred with percutaneous peritoneal lavage.

Conclusions

Percutaneous peritoneal lavage is a safe and effective minimally invasive alternative to laparoscopic peritoneal lavage for the diagnosis of metastatic gastric and pancreatic cancer. It is possible this can be utilized in an outpatient setting, such as during endoscopy, to allow for earlier diagnosis of M1 disease and decreased time to appropriate treatment.

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Acknowledgements

None.

Disclosure

Dr. Linda Pak received support from the Clinical and Translation Science Center at Weill Cornell Medical Center and Memorial Sloan Kettering Cancer Center (Grant Number UL1TR00457).

Funding

This work was supported in part by NIH/NCI P30 CA008748 Cancer Center Support Grant.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Linda M. Pak MD, Daniel G. Coit MD, Peter J. Allen MD, Michael I. D’Angelica MD, Ronald P. DeMatteo MD, William R. Jarnagin MD, Vivian E. Strong MD & T. Peter Kingham MD

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Anne A. Eaton MS

Authors
  1. Linda M. Pak MD
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  2. Daniel G. Coit MD
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  3. Anne A. Eaton MS
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  4. Peter J. Allen MD
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  5. Michael I. D’Angelica MD
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  6. Ronald P. DeMatteo MD
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  7. William R. Jarnagin MD
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  8. Vivian E. Strong MD
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  9. T. Peter Kingham MD
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Corresponding author

Correspondence to T. Peter Kingham MD.

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Pak, L.M., Coit, D.G., Eaton, A.A. et al. Percutaneous Peritoneal Lavage for the Rapid Staging of Gastric and Pancreatic Cancer. Ann Surg Oncol 24, 1174–1179 (2017). https://doi.org/10.1245/s10434-016-5757-3

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  • DOI: https://doi.org/10.1245/s10434-016-5757-3

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