Akademik Veri Yönetim Sistemi
EC GASTROENTEROLOGY AND DIGESTIVE SYSTEM, cilt.8, sa.10, ss.1-2, 2021 (Hakemli Dergi)
While gastric cancer is the fourth most common cancer around the world, it ranks third in cancer related deaths [1,2]. Since early-stage
gastric cancers do not have a specific symptoms, when the disease is diagnosed in gastric cancer patients, the patients are either in the
advanced stage or metastatic [3].
The stage of the disease is the most important factor determining the morbidity and mortality of the disease. Radiologic methods
(which includes pelvic and abdominal CT), Endoscopic Ultrasound (EUS), laparoscopy, peritoneal cytology for gastric cancer staging
[4]. Especially peritoneal cytology is one of the most emphasized studies recently. The peritoneum is one of the most common aera of
advanced gastric cancer and the presence of peritoneal implant is predictor of bad prognosis [3,5]. Peritoneal spread found poorly differentiated histologic type in early gastric cancers. Peritoneal disease has more greater impact than clinical TNM staging on survival [5].
Cytological examination also provides the possibility of laparoscopy. Laparoscopy can be a good way to diagnose metastasis in upper
gastrointestinal cancers before laparotomy. Metastatic lesions and peritoneal cavity can be visible with laparoscopy in in upper gastrointestinal cancers. Thus, unnecessary laparotomy can be prevent and it can be help in choosing the right treatment form [6].
Peritoneal cytology changes the treatment of the 25% of patients considered to be curative [5]. If the preoperative cytology status is
known, preoperative chemotherapy can be given, or curative treatment can be performed for negative cytology. Preoperative negative
peritoneal cytology increases survival rate more than positive peritoneal cytology. Positive cytology is considered stage IV cancer but
isn’t the same as with macroscopic peritoneal metastasis [7,8]. Curative resection isn’t beneficial in the presence of peritoneal disease.
Systemic chemotherapy or best supportive care is recommended for these patients according to the National Comprehensive Cancer
Network guidelines [5].
Since the rate of positive cytology is low in all patients, it is not practical and cost-effective to perform in all patients [9]. There is no
need for peritoneal cytology staging for early gastric cancers ((T1, T2 and N0)) detected by endoscopic ultrasound. While the rate of positive patient detection is approximately 4% in early gastric cancers ((T1, T2 and N0), it is 25% in T3/4, N+ tumors (10). Local advanced
tumors (T3-T4, N+) would likely gain the most benefit before curative resection from peritoneal staging [5].
In summary, peritoneal lavage cytology with high volumes should be use for true staging in gastric cancer. Restaging laparoscopic cytology should be used in positive peritoneal cytology after chemotherapy with no peritoneal metastasis patients. Negative peritoneal cytology with no peritoneal metastasis patients can be undergo definitive surgery [11]. In locally advanced gastric cancers, cytology should
be performed at the beginning of neoadjuvant chemotherapy or peri-operative [9].