Clinical Significance of Peritoneal Fluid Examination for Free Cancer Cells in Patients Qualified for Surgery for Gastric Cancer

Sławomir Cieśla; Radosław Lisiecki; Agnieszka Ławnicka; Bartosz Kudliński; Paulina Ostrowska; Alberto Davì; Massimiliano Veroux; Dawid Murawa

doi:10.3389/fsurg.2021.685868

Clinical Significance of Peritoneal Fluid Examination for Free Cancer Cells in Patients Qualified for Surgery for Gastric Cancer

Front Surg. 2021 Jun 21:8:685868. doi: 10.3389/fsurg.2021.685868. eCollection 2021.

Authors

Sławomir Cieśla¹, Radosław Lisiecki², Agnieszka Ławnicka¹, Bartosz Kudliński³, Paulina Ostrowska⁴, Alberto Davì⁵, Massimiliano Veroux⁶, Dawid Murawa^{1

7}

Affiliations

¹ General and Oncological Surgery Clinic of the K. Marcinkowski University Hospital in Zielona Góra, Zielona Góra, Poland.
² Department of General and Oncological Surgery of the Medical Centre in Pleszew, Pleszew, Poland.
³ Department of Anaesthesiology, Intensive Care and Emergency Medicine at Collegium Medicum of the University of Zielona Góra, Zielona Góra, Poland.
⁴ Department of Oncology of the Medical Centre in Pleszew, Pleszew, Poland.
⁵ Vascular and Endovascular Surgery Unit, Cuneo, Italy.
⁶ General Surgery Unit, Department of Medical and Surgical Sciences and Advanced Technologies University Hospital of Catania, Catania, Italy.
⁷ Department of Surgery and Oncology, Faculty of Medicine and Health Sciences of the University of Zielona Góra, Zielona Góra, Poland.

Abstract

Background: Peritoneal lavage cytology in patients with gastric cancer may correlate with an unfavorable prognosis. This study evaluated the presence of free cancer cells in the peritoneal lavage of a population of patients with gastric cancer and its correlation with the outcome of surgical treatment. Methods: One hundred patients diagnosed with gastric or gastrointestinal junction adenocarcinoma underwent surgery. In all patients, a cytological and immunohistochemical analysis of peritoneal lavage was performed. Based on the presence of free cancer cells (fcc) at the cytological and immunohistochemical examination of peritoneal lavage, patients undergoing surgery for gastric cancer were divided into two groups: fcc (+) and fcc (-). Results: A total of 100 patients, 37 women, and 63 men with a median age of 65 years were included in the study. In the entire study group, 16 (16%) patients were positive for the presence of free cancer cells (fcc +) at peritoneal lavage examination. However, in the group of patients who underwent gastrectomy, fcc (+) was found in 10 out of 77 (13%) patients. The presence of cancer cells in peritoneal lavage was a strong predictive factor in an unfavorable outcome after surgery, and 1-year and 2-year patient survival was 34 and 0% in fcc (+) patients and 79 and 59% in fcc (-), respectively. Moreover, the presence of free cancer cells was associated with a five-fold increased risk of death within 2 years after surgery. When analyzing the group of patients undergoing R0/R1 surgery, this difference was even more significant (p < 0.0001). Conclusions: The presence of free cancer cells in peritoneal lavage may significantly affect the outcome of patients with gastric cancer. Radical surgery in patients with free cancer cells in the peritoneal lavage did not result in a survival advantage. Identification of free cancer cells could help for a better stratification of gastric cancer patients, identifying those patients who could better benefit from a radical surgical treatment, finally improving long-term survival.

Keywords: free cancer cell; gastrectomy; gastric cancer; peritoneal lavage; prognosis; resection; sub-total gastrectomy; survival.