Detection of free malignant cells in the peritoneal cavity before and after resection of colorectal cancer.

PURPOSE

This study was designed to select the best monoclonal antibody to stain malignant cells in peritoneal wash fluid, and to investigate the incidence of free malignant cells in preresection and postresection colorectal cancer peritoneal washings using a combination of conventional cytology and immunocytochemistry.

METHODS

Peritoneal washings were taken from 35 consecutive patients undergoing colorectal cancer resection.

RESULTS

Malignant cells were isolated on a density gradient and identified by conventional cytology and an indirect immunoperoxidase stain. Malignant cells were identified in peritoneal washings from 15 patients (preresection only n = 3, postresection only n = 4, both n = 8). The origin of free malignant peritoneal cells in 11 preresection-positive washings must be the serosa. The origin of these cells in the four postresection-positive patients is uncertain: serosal and luminal spillage were considered unlikely and no circulating cells were found in the mesenteric vessels near the tumor.

CONCLUSION

Tumor cells may have leaked out from lymphatics cut during the dissection.