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Should Positive Cytology Revealed by Intraoperative Lavage Preclude Radical Resection in Resectable Pancreatic
Bing-Qi Li1, Hang-Yan Wang, Lei Li
1From the Department of General Surgery, Peking University Third Hospital, Beijing, China.
Pancreas
|April 26, 2023
Summary
Positive peritoneal lavage cytology (CY+) in pancreatic cancer patients indicates poor survival and higher recurrence. However, current evidence suggests CY+ alone does not preclude radical resection, warranting further research.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Pancreatic cancer prognosis is often poor, with peritoneal metastasis being a significant challenge.
- Positive peritoneal lavage cytology (CY+) is a marker associated with advanced disease.
- The role of CY+ in determining resectability for pancreatic cancer remains debated.
Purpose of the Study:
- To evaluate if positive peritoneal lavage cytology (CY+) is an absolute contraindication for radical resection in pancreatic cancer.
- To analyze the prognostic impact of CY+ on survival outcomes and recurrence rates.
- To identify areas for future research in managing CY+ pancreatic cancer.
Main Methods:
- Systematic review and meta-analysis of studies indexed in MEDLINE, Embase, and Cochrane Central.
- Analysis of dichotomous variables and survival outcomes using odds ratios and hazards ratios (HR).
- Inclusion of data from 4905 patients, with 7.8% testing positive for CY+.
Main Results:
- CY+ was significantly correlated with poorer overall survival (HR 1.62, P < 0.00001) and recurrence-free survival (HR 1.84, P < 0.00001).
- Patients with CY+ had a substantially higher initial peritoneal recurrence rate (OR 5.49, P < 0.00001).
- Despite these poor prognostic indicators, CY+ was not found to be an absolute contraindication for resection.
Conclusions:
- Positive peritoneal lavage cytology predicts poor prognosis and increased risk of peritoneal metastasis post-resection.
- Current evidence suggests CY+ alone is insufficient to preclude curative resection in pancreatic cancer.
- High-quality trials are needed to assess the prognostic impact of surgery in resectable CY+ patients, alongside developing better detection methods and treatments.
