Original Articles

Evaluation of Peritoneal Lavage for Gastric Cancer Staging in Patients Without Ascites Based on Cytology and Carcinoembryonic Antigen


Background: Imaging, cytological examination of ascites (if present), laparoscopy, and peritoneal lavage are performed before surgery for gastric cancer staging. Peritoneal lavage aims to diagnose the microscopic presence of tumor cells on the peritoneal surface. Positive cytology may have a prognostic value that classifies the disorder as stage IV, in which the patient is no longer an elective surgical candidate. Thus, our study was designed to assess the ability of peritoneal lavage to stage gastric cancer in non-ascitic patients based on cytological evaluation and carcinoembryonic antigen (CEA) level measurement. Methods: In our prospective study, we examined gastric cancer patients who were candidates for elective surgery. Upon entering the abdominal cavity and before tumor manipulation, normal saline (500 ml) was applied, and the abdominal cavity was thoroughly dispersed. After three minutes, the fluid was drained and addressed to cytological analysis and CEA measurement by radioimmunoassay (RIA). Study variables including age, sex, family history, tumor position, pathology, staging, grading, the original tumor size, regional lymph node involvement, and distant metastases were recorded during the pre-and postoperative staging. The association between positive peritoneal lavage cytology and various patients’ characteristics was investigated.  Results: In this study, 94 patients were screened. Due to lymphoma and gastrointestinal stromal tumor (GIST), two patients were excluded. We examined 92 patients, including 63 males (68.5 %) and 29 females (31.5 %). The mean age of patients was 58.52 ± 11.87 years. The most common tumor location was the esophagogastric junction. Moderately differentiated adenocarcinoma was the most frequent microscopic diagnosis. T3 was the most prevalent primary tumor size in 51 patients. Seventy-two patients (78.26%) were operable, of whom 18 (19.6 %) were positive for peritoneal lavage cytology. Positive cytology of peritoneal lavage was significantly related to tumor size, tumor grade, serosa/adjacent organ invasion (T4), laparoscopic staging findings, locally advanced disease (R0), and stage of the disease (P < 0.05). In the peritoneal lavage fluid, elevated CEA titers were significantly related to the high-grade tumor (P = 0.012). Conclusion: Our study demonstrated that positive cytology and high CEA titers in peritoneal lavage fluid of gastric cancer patients without ascites are significantly correlated to the advanced stages.
1. Winawer SJ. Gastric cancer: Worldwide burden and prevention opportunities. Chin J Dig Dis. 2005;6(3):107-9.
2. Sotoudeh M, Mirsamadi MM, Sedghi M. Comparison of the type of intera-cellular mucin in patients with H. pylori gastritis and normal population. Tehran Uni Med J 2002; 29:245.
3. Fauci AS, braumwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL et al. Harrison’s Principles of Internal Medicine. 17th edition. McGraw-Hill. 2008.
4. The seminar of gastric cancer available from: http:// publicrelations. tums. ac.ir/ news/detail.asp?newsID=7863
5. Salamatiran, Iranian Information Comprehensive Health Center. The most cancers in Iran, available from: http://www.iransalamat. com/index.php file=art.&operation=show&id=8625&subsectionId=338
6. de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D et al. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol. 2012 Jun;13(6):607-15.
7. What is gastric cancer available from :http: //www. ibcpars. net/ibcpars 0086. htm.
8. Wong J, Coit D. Detection of gastric cancer peritoneal metastases by peritoneal lavage: Current limitations and future perspectives. Surgery. 2012 Jul;152(1):1-4.
9. Frattini F, Rausei S, Chiappa C, Rovera F, Boni L, Dionigi G. Prognosis and treatment of patients with positive peritoneal cytology in advanced gastric cancer. World J Gastrointest Surg. 2013 May 27;5(5):135-7.
10. World Health Organization. Cancer: Fact Sheet No 297. WHO. Available at http://www.who.int/mediacentre/factsheets/fs297/en/. Accessed: May 21, 2015.
11. Tamura S, Fujiwara Y, Kimura Y, Fujita J, Imamura H, Kinuta M et al. Prognostic information derived from RT-PCR analysis of peritoneal fluid in gastric cancer patients: Results from a prospective multicenter clinical trial. J Surg Oncol. 2013 Oct 24. doi: 10.1002/jso.23472.
12. de Manzoni G, Verlato G, Di Leo A, Tomezzoli A, Pedrazzani C, Pasini F et al. Peritoneal cytology does not increase the prognostic information provided by TNM in gastric cancer. World J Surg. 2006 Apr;30(4):579-84.
13. Cetin B, Atalay C, Aslan S, Babacan B, Hatipoğlu C, Akinci M et al. Peritoneal carcinoembryonic antigen level for predicting locoregional and distant spread of gastric cancer. Surg Today. 2005;35(11):919-24.
14. Bryan RT, Cruickshank NR, Needham SJ, Moffitt DD, Young JA, Hallissey MT et al. Laparoscopic peritoneal lavage in staging gastric and oesophageal cancer. Eur J Surg Oncol. 2001 Apr;27(3):291-7.
15. Kanetaka K, Ito S, Susumu S, Yoneda A, Fujita F, Takatsuki M et al. Clinical significance of carcinoembryonic antigen in peritoneal lavage from patients with gastric cancer. Surgery. 2013 Sep;154(3):563-72.
16. Oh CA, Bae JM, Oh SJ, Choi MG, Noh JH, Sohn TS et al.Long-term results and prognostic factors of gastric cancer patients with only positive peritoneal lavage cytology. J Surg Oncol. 2012 Mar 15;105(4):393-9.
17. Leake PA, Cardoso R, Seevaratnam R, Lourenco L, Helyer L, Mahar A et al. A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer. Gastric Cancer. 2012 Sep;15 Suppl 1:S27-37.
18. Burke EC, Karpeh MS Jr, Conlon KC, Brennan MF. Peritoneal lavage cytology in gastric cancer: an independent predictor of outcome. Ann Surg Oncol. 1998 Jul-Aug;5(5):411-5.
19. Chuwa EW, Khin LW, Chan WH, Ong HS, Wong WK. Prognostic significance of peritoneal lavage cytology in gastric cancer in Singapore. Gastric Cancer. 2005;8(4):228-37.
IssueVol 12 No 3 (2020) QRcode
SectionOriginal Articles
DOI https://doi.org/10.18502/bccr.v12i3.5770
Gastric cancer Peritoneal lavage Carcinoembryonic antigen (CEA) Cytology

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Elyasinia F, Karimian F, Samiei F, Sadeghian E. Evaluation of Peritoneal Lavage for Gastric Cancer Staging in Patients Without Ascites Based on Cytology and Carcinoembryonic Antigen. Basic Clin Cancer Res. 2021;12(3):120-129.