Annals of Coloproctology

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Role of Peritoneal Lavage Cytology and Prediction of Prognosis and Peritoneal Recurrence After Curative Surgery for Colorectal Cancer: Sung Joon Bae, Ui Sup Shin, Young-Jun Ki, Sang Sik Cho, Sun Mi Moon, Sun Hoo Park; Ann Coloproctol. 2014;30(6):266-273. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.266

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13 Web of Science
12 Citations

Purpose

In colorectal cancer, the role of detecting free malignant cells from peritoneal lavage is currently unclear. In this study, we investigated the positive rate of free malignant cells in peritoneal lavage fluid and their predictive value for prognosis and peritoneal recurrence after a curative resection.

Methods

From October 2009 to December 2011, in a prospective manner, we performed cytologic examinations of peritoneal lavage fluid obtained just after the abdominal incision from 145 patients who underwent curative surgery for colorectal cancer. We used proportional hazard regression models to analyze the predictive role of positive cytology for peritoneal recurrence and survival.

Results

Among total 145 patients, six patients (4.1%) showed positive cytology. During the median follow-up of 32 months (range, 8-49 months), 27 patients (18.6%) developed recurrence. Among them, 5 patients (3.4%) showed peritoneal carcinomatosis. In the multivariate analysis, positive cytology was an independent predictive factor for peritoneal recurrence (hazard ratio [HR], 136.5; 95% confidence interval [CI], 12.2-1,531.9; P < 0.0001) and an independent poor prognostic factor for overall survival (HR, 11.4; 95% CI, 1.8-72.0; P = 0.009) and for disease-free survival (HR, 11.1; 95% CI, 3.4-35.8; P < 0.0001).

Conclusion

Positive cytology of peritoneal fluid was significantly associated with peritoneal recurrence and worse survival in patients undergoing curative surgery for colorectal cancer. Peritoneal cytology might be a useful tool for selecting patients who need intraperitoneal or systemic chemotherapy.

Citations

Citations to this article as recorded by

Intraoperative flow cytometry in detecting free carcinoma cells in peritoneal lavage fluid of gastric carcinoma cases
Thulasi Raman Ramalingam, Bharaneedharan Marimuthu, Harsha N. Rasheed, Archana Lakshmanan, Swetha Lakshmi Narla, Lakshman Vaidhyanathan, Ajit Pai
Cytometry Part B: Clinical Cytometry.2025;[Epub] CrossRef
Peritoneal Lavage Cytology Predicts Peritoneal Metastasis and is Associated with Poor Prognosis in Patients with Stage II–III Colorectal Cancer
Dewei Kong, Yingjie Li, Shenyi Yin, Yunfei Tan, Boyang Qu, Lei Huang, Jianzhong Jeff Xi, Aiwen Wu
Annals of Surgical Oncology.2025;[Epub] CrossRef
Risk Factors for Positive Peritoneal Lavage Cytology in Stage I to III Colon Cancer: A Prospective Observational Study
Radha Raman Mondal, Subrata Sahu, Sudip Haldar, Samir Bhattacharyya, Arnab Gupta
Indian Journal of Surgical Oncology.2025;[Epub] CrossRef
Development and validation of a nomogram to predict overall survival in patients with incidental gallbladder cancer: A retrospective cohort study
Zhi-Hua Xie, Xuebing Shi, Ming-Qi Liu, Jinghan Wang, Yong Yu, Ji-Xiang Zhang, Kai-Jian Chu, Wei Li, Rui-Liang Ge, Qing-Bao Cheng, Xiao-Qing Jiang
Frontiers in Oncology.2023;[Epub] CrossRef
Effect of Intraperitoneal Chemotherapy with Regorafenib on IL-6 and TNF-α Levels and Peritoneal Cytology: Experimental Study in Rats with Colorectal Peritoneal Carcinomatosis
Stefanos Bitsianis, Ioannis Mantzoros, Elissavet Anestiadou, Panagiotis Christidis, Christos Chatzakis, Konstantinos Zapsalis, Savvas Symeonidis, Georgios Ntampakis, Kalliopi Domvri, Anastasia Tsakona, Chryssa Bekiari, Orestis Ioannidis, Stamatios Aggelop
Journal of Clinical Medicine.2023; 12(23): 7267. CrossRef
Conventional peritoneal cytology lacks the prognostic significance of detecting local or peritoneal recurrence in colorectal cancer: An Egyptian experience
Mohamed Shalaby, Tarek S El Baradie, Mohamed Salama, Hebat A M Shaaban, Rasha M Allam, Ehab O.A. Hafiz, Mohamed Aly Abdelhamed, Amr Attia
JGH Open.2021; 5(2): 264. CrossRef
Interleukin 10 level in the peritoneal cavity is a prognostic marker for peritoneal recurrence of T4 colorectal cancer
Seung-Yong Jeong, Byeong Geon Jeon, Ji-Eun Kim, Rumi Shin, Hye Seong Ahn, Heejin Jin, Seung Chul Heo
Scientific Reports.2021;[Epub] CrossRef
Risk factors for developing peritoneal metastases after curative surgery for colorectal cancer: A systematic review and meta‐analysis
Yuanxin Zhang, Xiusen Qin, Wenle Chen, Duo Liu, Jian Luo, Huaiming Wang, Hui Wang
Colorectal Disease.2021; 23(11): 2846. CrossRef
Treatment for Peritoneal Metastasis of Patients With Colorectal Cancer
Young Jin Kim, Chang Hyun Kim
Annals of Coloproctology.2021; 37(6): 425. CrossRef
Pathophysiology of colorectal peritoneal carcinomatosis: Role of the peritoneum
Lieselotte Lemoine, Paul Sugarbaker, Kurt Van der Speeten
World Journal of Gastroenterology.2016; 22(34): 7692. CrossRef
The preoperative platelet to lymphocyte ratio is a prognostic marker in patients with stage II colorectal cancer
Tsuyoshi Ozawa, Soichiro Ishihara, Takeshi Nishikawa, Toshiaki Tanaka, Junichiro Tanaka, Tomomichi Kiyomatsu, Keisuke Hata, Kazushige Kawai, Hiroaki Nozawa, Shinsuke Kazama, Hironori Yamaguchi, Eiji Sunami, Joji Kitayama, Toshiaki Watanabe
International Journal of Colorectal Disease.2015; 30(9): 1165. CrossRef
Intraoperative Peritoneal Lavage: Limitations of Current Evidence for Clinical Implementation
Duck-Woo Kim
Annals of Coloproctology.2014; 30(6): 248. CrossRef

A Prospective Study on the Significance of Peritoneal Washing Cytology as a Diagnostic Modality in Colorectal Cancer.: Park, Jeong Mi , Yun, Min Young , Choi, Yoon Mee , Choi, Sun Keun , Hur, Yoon Suk , Lee, Kun Young , Kim, Sei Joong , Cho, Young Up , Ahn, Seung Ik , Hong, Kee Chun , Shin, Suk Hwan , Kim, Kyung Rae , Woo, Ze Hong; J Korean Soc Coloproctol. 2007;23(6):483-489.; DOI: https://doi.org/10.3393/jksc.2007.23.6.483

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Abstract PDF: PURPOSE
Free intraperitoneal cancer cells exfoliated from a tumor are considered to be responsible for peritoneal dissemination. Therefore, microscopic evaluation of cells washed from the peritoneal cavity during surgery for various intraabdominal malignancies has been used to detect subclinical intraperitoneal metastases from these tumors. The purposes of this study were to detect intraperitoneal free cancer cells at the time of surgery by using peritoneal washing cytology in colorectal cancer and to evaluate their diagnostic significance.
METHODS
During the 29-month period from January 2000 through May 2002, 149 randomly selected patients with primary colorectal cancer without evidence of gross peritoneal metastasis underwent peritoneal washing cytologic analysis before surgical manipulation of the tumor. Peritoneal washing cytology was compared with the pre-existing prognostic factors.
RESULTS
Positive peritoneal washing for free cancer cells was found in 19 of 149 patients (12.8%). This positivity was significantly correlated with histologic grade (P=0.002), serosal invasion (P=0.025), lymph node metastasis (P=0.034), Astler-Coller classification (P=0.008), recurrence (P<0.001), and 5-year survival (P<0.001). Cancer-specific survival was significantly associated with histologic grade (P=0.025), peritoneal washing cytology (P<0.001), lymph node metastasis (P<0.001), recurrence (P<0.001), and stage (P= 0.010) in the multivariate analysis.
CONCLUSIONS
The presence of free cancer cells was predictive of survival and was an independent prognostic factor. This information may be useful in stratifying patients with colorectal cancer for therapeutic trials, such as intraperitoneal chemotherapy.

The Significance of Peritoneal Effusion in Colorectal Cancer.: Lee, In Kyu , Yi, Jeong Min , Lee, Yoon Suk , Kim, Hyung Jin , Park, Jong Kyung , Oh, Seong Taek , Kim, Jun Gi , Jeon, Hae Myung , Chang, Suk Kyun; J Korean Soc Coloproctol. 2006;22(5):308-313.

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5 Download

Abstract PDF: PURPOSE
It has been reported that in colorectal cancer, the positive rate of the cytological examination of ascites is low and that the cytologically positive result of the cancer cell influences its prognosis; nonetheless, not many studies on the correlation of the formation of peritoneal effusion and cancer have been done yet. Thus, this study on the correlation of clinico-pathological findings with peritoneal effusion was initiated.
METHODS
The study population, includes a total of 191 patients who underwent an operation for colon cancer and rectal cancer from May 1, 2004, to December 31, 2005. Peritoneal effusion considered to be present in cases with more than 10 cc of body fluid retained in the Douglas pouch, and a cytological test was performed on patients whose retained fluid was more than 50 cc. In all patients, the correlation of the clinico-pathological findings with peritoneal effusion was analyzed, and the volume of effusion and the positive result of peritoneal cytology were compared.
RESULTS
Among the 191 patients, patients without peritoneal effusion numbered 133 (69.6%) and patients with peritoneal effusion numbered 58 (30.4%). Between the two groups, the presence of intestinal obstruction due to cancer (P<0.001), perineural involvement (P=0.025), lymph node metastasis (P=0.004), lymph-node stage (P=0.001), distal metastasis (P=0.012), macroscopic peritoneal dissemination, and stage (P=0.017) were statistically significantly different. In the multivariate analysis, only the presence of intestinal obstruction and lymph-node disease stage correlated statistically significantly to the formation of peritoneal effusion (P=0.009, 0.004). Twenty patients (34.5%) had peritoneal effusion of more than 50 cc, and among them, malignant cells were detected in 3 patients (15%). Based on 50-cc peritoneal effusion, more or less effusion and the detection of malignant cells by peritoneal cytology did not correlate with the clinico- pathological outcomes (P>0.05).
CONCLUSIONS
For colorectal cancer patients with peritoneal effusion, but without co-morbid medical diseases inducing such peritoneal effusion, by regarding peritoneal effusion itself as meaningful, the range of lymphadenectomies, adjuvant chemotherapy, and other additional therapy should be considered.

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