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Masaru Konishi, MD; Taira Kinoshita, MD; Toshio Nakagohri, MD; Kazuto Inoue, MD; Tatsuya Oda, MD; Shinichiro Takahashi, MD

Arch Surg. 2002;137:475-480.

Hypothesis  Findings from cytologic examination of peritoneal washings affect the staging, prognosis, and management of pancreatic cancer.

Design  Retrospective review.

Setting  Tertiary care center.

Patients  A total of 151 patients with invasive ductal adenocarcinoma of the pancreas and without distant metastases or ascites, as determined by preoperative radiologic examinations, underwent peritoneal washings. Based on intraoperative findings, patients were subdivided into 3 groups according to the extent of cancer spread: 65 were assigned to a resectable group, 53 to a locally advanced group, and 33 to a visible metastases group.

Main Outcome Measures  Survival and peritoneal metastases-free survival.

Results  The incidence of positive cytologic findings was 23.8% (36/151). Positive rates increased significantly with disease progression (P<.001). In the resectable group, survival and peritoneal metastases-free survival were significantly shorter for patients with positive vs negative cytologic findings. In the remaining 2 groups, no differences were observed between patients with positive vs negative cytologic findings in survival or peritoneal metastases-free survival. In patients with positive cytologic findings without visible metastases, survival and peritoneal metastases-free survival were significantly better in the locally advanced group undergoing chemoradiotherapy than in the resectable group.

Conclusions  Positive peritoneal cytologic findings are not independent factors that determine survival and peritoneal metastases-free survival; rather, they are associated with advanced disease. In patients with visible metastases, cytologic factors are not correlated with survival or peritoneal recurrence. In patients without visible metastases, chemoradiotherapy may be beneficial for those with positive cytologic findings.

From the Department of Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

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