Pak Linda M, Coit Daniel G, Eaton Anne A, Allen Peter J, D'Angelica Michael I, DeMatteo Ronald P, Jarnagin William R, Strong Vivian E, Kingham T Peter
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2017 May;24(5):1174-1179. doi: 10.1245/s10434-016-5757-3. Epub 2017 Jan 5.
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.
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.
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.
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.
在胃癌和胰腺癌中，阳性腹膜细胞学被归类为M1期疾病。虽然腹膜细胞学通常通过腹腔镜腹膜灌洗获取，但本研究旨在探讨在监测麻醉护理下经皮进行腹膜灌洗，并与其他诊断程序相结合以浓缩和加快分期过程的可行性和安全性。
计划进行腹腔镜腹膜灌洗的胃癌或胰腺癌患者被前瞻性纳入，在腹腔镜腹膜灌洗之前先进行术中经皮腹膜灌洗。通过经皮插入的导管注入生理盐水，并收集液体用于腹膜细胞学检查。腹腔镜检查期间收集的三个象限的灌洗液也送去进行腹膜细胞学检查。主要结果是评估经皮腹膜灌洗与腹腔镜腹膜灌洗这一金标准相比检测阳性腹膜细胞学的敏感性和特异性，次要结果是确定安全性。
76例患者中有70例（92%）成功进行了经皮腹膜灌洗。48例胃癌患者中有10例（21%）以及22例胰腺癌患者中有3例（14%）经皮和腹腔镜腹膜细胞学检查均为阳性。另外2例胃癌患者仅腹腔镜腹膜细胞学检查为阳性。与腹腔镜腹膜灌洗相比，经皮腹膜灌洗的敏感性和特异性分别为87%和100%。经皮腹膜灌洗未发生并发症。
经皮腹膜灌洗是一种安全有效的微创替代方法，可用于诊断转移性胃癌和胰腺癌，替代腹腔镜腹膜灌洗。有可能在门诊环境中使用，例如在内镜检查期间，以便更早诊断M1期疾病并缩短至适当治疗的时间。
