Risk factors for peritoneal dissemination of gastric cancer

Tumor dissemination, lymphnode involvement and surgical resection technique are the most important factors affecting patient prognosis with gastric cancer. Peritoneal dissemination adversely affects the survival rate in patients. Microscopic peritoneal dissemination can be detected with peritoneal lavage cytological examination. Peroperatively detected microscopic peritoneal dissemination changes the treatment plan for patients and can be useful when selecting patients who should undergo adjuvant chemotherapy.

At the Trakya Universtity Faculty of Medicine, General Surgery Department, a 41-year-old patient who was macroscopic peritoneal dissemination during the dates January-December 2011 was included in the study. Perioperative peritoneal lavage was performed and cytological examination of peritoneal aspirate carried out. Using tumor markers the relationship between lymph node metastasis, prognostic type, tumor location and perineural invasion was investigated on the serum and peritoneal fluid.

Forty-one patients were operated on; 10 of them (24.4%) had positive malignant cytology and 31 (75.7%) had negative cytology. Just 1 (7.2%) patient was found to have positive cytology out of 13 (31.7%) that did not have serous invasion. Of the 28 (68.3%) patients with serous invasion, 9 patients (32.1%) were found to have positive cytology. No significant pattern was detected in the carcino-embryionic antigen, cancer antigen 19-9 and AFP levels in both the positive and negative cytology serum and peritoneal lavage fluid. Of the 41 patients operated on 5 (12.2%) were found to have cardia dissemination and 13 (31.7%) were found to have dissemination located at the corpus. Peritoneal dissemination was found to be significantly high in gastric cancer located in the cardia and corpus. Fourteen (34.1%) of the patients had stage I and stage II cancer and 27 (65.9%) of patient's had cancer in stages III and IV. Just 1 (7.1%) patient with stage I or II cancer was found to have positive malignant cytology, however 9 (33.3%) patient's of stage III and IV gastric cancer patients were tested positively for malignant cytology.

A positive relationship was detected in the positive peritoneal cell malignancy with cancer stage, age, invasion depth and tumor location in patients.