1
|
Sato H, Kotake K, Maeda K, Kobayashi H, Takahashi H, Sugihara K. Factors Affecting Positive Peritoneal Lavage Cytology in Patients with Stage II and III Colorectal Cancer with R0 Resection: A Multi-institutional, Prospective Study. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:355-365. [PMID: 34746500 PMCID: PMC8553352 DOI: 10.23922/jarc.2021-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
Objectives: This study aimed to explore the risk factors associated with cancer cell exfoliation in Stage II and III colorectal cancer (CRC). Methods: This multicenter, prospective, observational study targeted 1,698 patients with cStage II and III CRC who underwent R0 resection between 2013 and 2017. Clinicopathological variables were analyzed for correlations with positive peritoneal lavage cytology (PLC). Results: The positive PLC rate was 2.7% (46/1,694 cases) at laparotomy and 1.6% (25/1,590 cases) after tumor resection. Logistic regression analyses identified that undifferentiated histologies diagnosed by preoperative biopsy specimen, cT4, and pN+ were independent factors that affected the positive PLC at laparotomy. The positive PLC rate at laparotomy was 4.5% (33/736 cases) among the patients with undifferentiated histology and/or cT4. Logistic regression analyses revealed that the presence of ascites and undifferentiated histology by biopsy independently affected positive PLC after tumor resection. Conclusions: The undifferentiated histology and/or T4 indicated by preoperative diagnosis were identified as factors affecting PLC at laparotomy. Furthermore, ascites and preoperative histological type were identified as factors affecting positive PLC after tumor resection. As factors affecting positive PLC, these preoperative findings were found to be equivalent to pathological findings.
Collapse
Affiliation(s)
- Harunobu Sato
- Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum.,Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Kenjiro Kotake
- Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum.,Department of Surgery, Sano City Hospital, Sano, Japan
| | - Kotaro Maeda
- Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum.,Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Hirotoshi Kobayashi
- Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum.,Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Hiroshi Takahashi
- Department of Medical Statistics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenichi Sugihara
- Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum.,Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
2
|
Zhou J, Liu C, Man S, Lyu M, Liao H, Chen N, Cheng Y, Liu L. Comparison of the clinical benefits for non-small cell lung cancer patients between different volume of pleural lavage fluid following video-assisted thoracoscopic lobectomy and systematic mediastinal lymph node dissection: study protocol for a randomized controlled trial. Trials 2020; 21:232. [PMID: 32106877 PMCID: PMC7047403 DOI: 10.1186/s13063-020-4146-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/06/2020] [Indexed: 02/08/2023] Open
Abstract
Background Pleural lavage is regularly performed before closing the chest wall in pulmonary surgeries to prevent pleural implantation of tumor cells and postoperative infection. However, scant data could be found in the literature regarding the optimal regimen for performing pleural lavage. To establish a proper volume of pleural lavage, we herein designed a protocol for a randomized controlled trial. Methods A total of 400 participants with non-small cell lung cancer undergoing video-assisted thoracoscopic surgery (VATS) lobectomy and systematic mediastinal lymph node dissection (MLND) will be randomly assigned to one of two groups: group A (500 mL pleural lavage fluid) and group B (3000 mL pleural lavage fluid). The primary outcomes include the levels of leukocytes, neutrophils, and inflammatory factors on the first postoperative day. The secondary outcomes include (i) the levels of leukocytes, neutrophils, and inflammatory factors on the second and third postoperative days; (ii) the incidence of postoperative fever on the first, second, and third postoperative days; (iii) the volumes of chest drainage within the first 3 operative days, the duration of drainage, and postoperative hospitalization; and (iv) the incidence of postoperative complications (incision infection, pain, atelectasis, hemorrhage, etc.) and the incidence of pleural effusion requiring thoracic puncture or drainage within 30 days after surgery. The main content of the analysis includes effectiveness and safety analysis. We will perform subgroup analyses to identify potential influence factors. Discussion As far as we know, this will be the first randomized controlled trial to compare the clinical outcomes between different volumes of pleural lavage fluid following VATS and MLND. Findings from this trial will determine the appropriate amount of pleural lavage before chest wall closure. Trial registration This study was registered with the Chinese Clinical Trial Registry ( on 17 March 2019. ChiCTR 1900021950).
Collapse
Affiliation(s)
- Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Shulei Man
- West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Mengyuan Lyu
- West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Hu Liao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.,West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Yuhui Cheng
- West China School of Medicine, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China. .,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
3
|
Chen D, Fu R, Shi P, Qin S, Chen C. [Latest Progress of Intraoperative Pleural Lavage Cytology in Lung Cancer Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:719-726. [PMID: 30201073 PMCID: PMC6137007 DOI: 10.3779/j.issn.1009-3419.2018.09.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
非小细胞肺癌(non-small cell lung cancer, NSCLC)根治术中胸腔冲洗液细胞学检查是一种常用的检测肿瘤进展并评估患者预后的诊断技术。长期以来大量研究者致力于阐明术中胸腔冲洗液细胞学检查结果与肺癌患者术后生存及肿瘤复发转移的关系。由于不同研究间存在明显异质性,其结论也各有不同。但能肯定的是,胸腔冲洗液肿瘤细胞检查阳性已被证实为手术患者的不良预后因素之一。本文尝试从临床意义、影响因素及可能发生机制等角度就近年来术中胸膜腔冲洗的研究进展作一综述。
Collapse
Affiliation(s)
- Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Ranran Fu
- Tongji University School of Medicine, Shanghai 200092, China
| | - Pingfan Shi
- Tongji University School of Medicine, Shanghai 200092, China
| | - Shuang Qin
- Tongji University School of Medicine, Shanghai 200092, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| |
Collapse
|
4
|
Nakamura T, Otsuki Y, Nakamura H, Funai K. Pleural lavage cytology after lung resection in patients with non-small cell lung cancer and the feasibility of 20 mL saline solution. Asian J Surg 2018; 42:283-289. [PMID: 29628439 DOI: 10.1016/j.asjsur.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND There are two issues to be discussed in pleural lavage cytology (PLC) for resected non-small cell lung cancer (NSCLC) whether it should be performed before (pre-PLC) or after (post-PLC) the lung resection and the dose of saline varies widely among the institutions. METHODS We retrospectively reviewed the clinical records of 466 consecutive patients who underwent a curative resection for NSCLC and received both a pre- and post- PLC using 20 mL of saline from January 2001 to December 2011. RESULTS There were 24/28 of positive pre- and post-PLC and 442/438 negative pre- and post-PLCs, respectively. Patients with a positive pre- or post-PLCs had significantly worse 5-year survival rates than those with negative results (pre-PLC positive/negative; 32.6%/69.9%, p = 0.001, post-PLC positive/negative; 21.4%/71.1%, p < 0.001, respectively). The post-PLC (p = 0.01) was an independent prognostic factor for the overall survival by a multivariate analysis, whereas the pre-PLC was not (p = 0.79). CONCLUSIONS The post-PLC was a more significant prognostic factor than the pre-PLC. Further, 20 mL of saline seemed feasible because of the consistent results compared to the past reports using a greater dose of saline for regarding the positive rates of the PLC and its prognostic significance.
Collapse
Affiliation(s)
- Toru Nakamura
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, Japan.
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, Japan
| | - Hidenori Nakamura
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Hamamatsu, Shizuoka, Japan
| |
Collapse
|
5
|
Sugimura K, Miyata H, Motoori M, Omori T, Fujiwara Y, Yano M. The Significance of SCC and CEA mRNA in the Pleural Cavity After Lymphadenectomy in Esophageal Cancer Patients who Underwent Preoperative Treatment. World J Surg 2017; 42:749-757. [DOI: 10.1007/s00268-017-4203-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
6
|
Prognostic Value of Pleural Lavage Cytology in Patients with Lung Cancer Resection: An Updated Meta-Analysis. PLoS One 2016; 11:e0157518. [PMID: 27458805 PMCID: PMC4961387 DOI: 10.1371/journal.pone.0157518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/30/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Pleural lavage cytology (PLC) is considered as a possible tool for assessing prognosis of lung cancer patients. We aimed to comprehensively review the prognosis value of PLC in patients undergoing surgical resection. METHODS We searched 4 electronic databases for relevant studies comparing positive PLC and negative PLC. The primary outcomes included survival rate and recurrence rate at maximum follow-up. RESULTS The meta-analysis included 28 studies, with a total of 20,714 patients. For the overall survival rate of all stages, the results demonstrated that positive pre-resection, post-resection and pooled PLC were associated with unfavorable survival: hazard ratio (HR) 2.89 (95% confidence interval [CI] 2.48-3.37), 2.70 (1.90-3.83), and 2.89 (2.52-3.31), respectively. For the stage I survival rate, the combined results also suggested that positive pre-resection, post-resection and pooled PLC were associated with unfavorable survival: HR 3.29 (95% CI 2.55-4.25), 4.85 (2.31-10.20), and 3.16 (2.53-3.94), respectively. Furthermore, a meta-analysis of 14 studies included 14,279 patients showed that positive pre-resection, post-resection and pooled PLC were associated with an increased risk of overall recurrence: risk ratio (RR) 2.45 (95% CI 1.91-3.15), 2.37 (1.11-5.09), and 2.37 (95% CI 2.00-2.80), respectively. Positive PLC was also associated with a high pleural recurrence (RR 4.77; 95% CI 3.13-7.26) or distant recurrence (RR 2.33; 95% CI 1.65-3.29). CONCLUSIONS Both positive pre- resection and post-resection PLC are associated with not only higher tumor recurrence but also unfavorable survival outcomes in patients with lung cancer resection. This technique can therefore act as a strong prognostic factor for tumor recurrence and adverse survival rates.
Collapse
|
7
|
Shoji F, Yamazaki K, Kouso H, Mori R, Takeo S. The Impact of Pleural Lavage Cytology Both Before and After Lung Resection on Recurrence of Non-Small Cell Lung Cancer. Ann Thorac Surg 2016; 101:2141-6. [DOI: 10.1016/j.athoracsur.2015.12.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022]
|
8
|
Kameyama K, Okumura N, Miyaoka E, Asamura H, Yoshino I, Tada H, Fujii Y, Nakanishi Y, Eguchi K, Mori M, Kobayashi H, Sawabata N, Okumura M, Yokoi K. Prognostic value of intraoperative pleural lavage cytology for non–small cell lung cancer: The influence of positive pleural lavage cytology results on T classification. J Thorac Cardiovasc Surg 2014; 148:2659-64. [DOI: 10.1016/j.jtcvs.2014.07.090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 06/23/2014] [Accepted: 07/13/2014] [Indexed: 11/26/2022]
|
9
|
Clinical significance of muscle layer interruption in T3 esophageal cancer. Esophagus 2014. [DOI: 10.1007/s10388-014-0420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
10
|
Pleural lavage cytology: Where do we stand? Lung Cancer 2014; 83:14-22. [DOI: 10.1016/j.lungcan.2013.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 10/08/2013] [Accepted: 10/18/2013] [Indexed: 11/19/2022]
|
11
|
Kang MJ, Han SS, Jang JY, Park JW, Kwon W, Chang YR, Kim SW. Cancer cells with p53 deletion detected by fluorescent in situ hybridization in peritoneal drainage fluid is correlated with early peritoneal seeding in resectable pancreatic cancer. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:209-15. [PMID: 23577315 PMCID: PMC3616274 DOI: 10.4174/jkss.2013.84.4.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 01/08/2013] [Accepted: 02/20/2013] [Indexed: 01/26/2023]
Abstract
Purpose Free tumor cells in peritoneal fluid in patients with pancreatic cancer may have prognostic significance but there are few reports on methods for the effective detection of free tumor cells. The aims of this study were to identify free cancer cells in peritoneal fluid with fluorescent in situ hybridization (FISH) technique and to investigate its prognostic significance. Methods Twenty-eight patients with resectable pancreatic cancer who underwent surgical resection were included. Peritoneal washing and peritoneal drainage fluid were examined by FISH for p53 deletion. Results Among the study subjects, the R0 resection rate was 75%. None of the patients had positive cytology with Papanicolaou's method. p53 deletion was detected in 9 peritoneal washings (32.1%) and in 5 peritoneal drainage fluids (17.9%). After a median of 18 months of follow-up, 25 patients (89.3%) experienced recurrence and 14 patients (50.0%) had peritoneal seeding. Patients with p53 deletion detected in the peritoneal drainage fluid had positive radial margin (60.0% vs. 17.4%, P = 0.046) more frequently and a lower peritoneal metastasis free survival (median, 11.1 months vs. 30.3 months; P = 0.030). Curative resection (P < 0.001) and p53 deletion in peritoneal drainage fluid (P = 0.030) were independent risk factors of peritoneal metastasis free survival after multivariate analysis. Conclusion FISH technique detects free cancer cells with higher sensitivity compared to Papanicolaou's method. p53 deletion detected in peritoneal drainage fluid is correlated with positive radial resection margin and results in early peritoneal seeding. Patients with p53 deletion in peritoneal drainage fluid need more aggressive adjuvant treatment.
Collapse
Affiliation(s)
- Mee Joo Kang
- Department of Surgery, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
12
|
Kaczmarczyk G, Lewandowski R, Trautsolt W, Ziółkowski A, Kozielski J. Cytological examination of pleural cavity lavage accompanied by the study of gene promoter hypermethylation of p16 and O6-methylguanine-DNA-methyltransferase genes in diagnostics of non-small cell lung cancer metastatic changes into pleura. Contemp Oncol (Pozn) 2012; 16:322-7. [PMID: 23788902 PMCID: PMC3687432 DOI: 10.5114/wo.2012.30061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 06/25/2012] [Accepted: 07/18/2012] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Metastases of non-small cell lung cancer (NSCLC) into pleura disqualify a patient from surgery and present a bad prognostic index. The aim of the study was to find out whether washing out the pleural cavity in such cases and examining obtained washings for presence of cancer cells will help to detect early NSCLC metastases into pleura, and also whether negative results of the cytology determine whether hypermethylation of these genes will increase the sensitivity of this examination. MATERIAL AND METHODS The study consisted of the examination of 76 patients, including 59 operated on for NSCLC and 17 operated on for other reasons. Pleural washing fluid collected during the surgery was subjected to cytological examination as well as examined to determine the presence of promoter region hypermethylation of p16 and MGMT genes. RESULTS Positive cytological results of pleural lavage were confirmed in 4 persons (7%) with NSCLC. The presence of promoter region hypermethylation of one or both examined genes was found in 3 patients (18%) in the control group and in 47 (80%) in the study group. Sex, occupational exposure, smoking cigarettes, and NSCLC histological type did not have an influence on the presence of cancer cells or hypermethylation in the pleural lavage fluid. Positive cytology results were more frequent at the T4 stage of NSCLC. Hypermethylation was more frequent in the research group (p < 0.01). Cancer cells and hypermethylation did not occur more frequently in pleural lavage fluid of patients with metastases into pleura. CONCLUSIONS The cytological examination and promoter region hypermethylation assessment of the p16 gene and MGMT gene in pleural lavage cells do not allow one to detect early metastasis of NSCLC into pleura.
Collapse
Affiliation(s)
- Grzegorz Kaczmarczyk
- Department and Clinic of Lung Diseases and Tuberculosis in Zabrze, Silesian Medical University in Katowice, Poland
| | - Roman Lewandowski
- Department and Clinic of Thoracosurgery in Zabrze, Silesian Medical University in Katowice, Poland
| | - Wanda Trautsolt
- Department and Clinic of Internal Medicine and Diabetology in Zabrze, Silesian Medical University in Katowice, Poland
| | - Adam Ziółkowski
- Department of Pathomorphology in Zabrze, Silesian Medical University in Katowice, Poland
| | - Jerzy Kozielski
- Department and Clinic of Lung Diseases and Tuberculosis in Zabrze, Silesian Medical University in Katowice, Poland
| |
Collapse
|
13
|
Impact of positive pleural lavage cytology on survival in patients having lung resection for non–small-cell lung cancer: An international individual patient data meta-analysis. J Thorac Cardiovasc Surg 2010; 139:1441-6. [DOI: 10.1016/j.jtcvs.2009.05.048] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 04/24/2009] [Accepted: 05/16/2009] [Indexed: 10/20/2022]
|
14
|
Aokage K, Yoshida J, Ishii G, Enatsu S, Hishida T, Nishimura M, Nishiwaki Y, Nagai K. The impact on survival of positive intraoperative pleural lavage cytology in patients with non–small-cell lung cancer. J Thorac Cardiovasc Surg 2010; 139:1246-52, 1252.e1. [DOI: 10.1016/j.jtcvs.2009.07.049] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 06/09/2009] [Accepted: 07/16/2009] [Indexed: 11/16/2022]
|
15
|
Long-term prognostic value of conventional peritoneal lavage cytology in patients undergoing curative colorectal cancer resection. Dis Colon Rectum 2009; 52:1312-20. [PMID: 19571710 DOI: 10.1007/dcr.0b013e3181a745a4] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Free malignant cells in the peritoneal cavity might play a role in the metastasis process. However, this phenomenon needs further elucidation. The aims of this study were to investigate the frequency of free cancer cells detected on cytologic examination of lavage fluid after peritoneal washing in patients undergoing curative surgery for colorectal cancer, to explore risk factors for exfoliation of cancer cells into the peritoneal cavity, and to evaluate the influence peritoneal lavage cytology as a prognostic tool. METHODS Peritoneal lavage was performed in 697 patients undergoing curative resection of colorectal cancer. Before the manipulation of the tumor, 100 mL of physiologic saline solution was administered into the abdominal cavity and the fluid was collected for cytologic examination. Specimens were classified as positive if at least one cancer cell was detected. RESULTS The mean follow-up period was 90.5 months. Overall, 15 (2.2%) of the 697 patients had positive results. Four characteristics were identified as risk factors for exfoliation of cancer cells into the peritoneal cavity: 1) depth of invasion, 2) regional lymph nodes, 3) lymphatic invasion, and 4) venous invasion. In univariate analyses of all 697 patients and the subgroup of 374 patients with pT3 or T4 tumors, patients with positive cytology findings had significantly worse disease-free and cancer-specific survival than patients with negative cytology findings (P < 0.001). On multivariate analysis, peritoneal cytology remained an independent predictor of cancer-specific survival in all patients and in patients with pT3 or pT4 tumors. Only peritoneal cytology was a significant prognostic factor for peritoneal recurrence (P < 0.0001). CONCLUSION Conventional peritoneal cytology is a useful prognostic tool in patients undergoing curative surgery for colorectal cancer and may be helpful in making decisions whether to select intraperitoneal or systemic chemotherapy.
Collapse
|
16
|
Li YN, Shi HZ, Liang QL, Yang HB, Huang GM. Prognostic significance of pleural lavage cytology in patients with lung cancer: A meta-analysis. Lung Cancer 2008; 60:183-92. [DOI: 10.1016/j.lungcan.2007.09.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 09/28/2007] [Accepted: 09/29/2007] [Indexed: 10/22/2022]
|
17
|
Nakagawa T, Okumura N, Kokado Y, Miyoshi K, Matsuoka T, Kameyama K. Clinical relevance of intraoperative pleural lavage cytology in non-small cell lung cancer. Ann Thorac Surg 2007; 83:204-8. [PMID: 17184663 DOI: 10.1016/j.athoracsur.2006.07.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 07/14/2006] [Accepted: 07/18/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intraoperative pleural lavage cytology for patients with lung cancer has been reported to be useful in detecting subclinical pleural dissemination. However, this procedure is not necessary for the staging of lung cancer in the current TNM staging system. METHODS Clinical records of 1025 patients with non-small cell lung cancer who underwent surgery were retrospectively reviewed and evaluated for the clinical relevance of intraoperative pleural lavage cytology. RESULTS Specimens of 37 patients (3.6%) were positive for pleural lavage cytology (PLC). Patients were categorized into three groups: positive PLC group, 27 patients with positive PLC without malignant pleural effusion or pleural dissemination; pleural dissemination (PD) group, 21 patients with malignant pleural effusion or PD; negative PLC group, 977 patients with negative PLC or negative PLC without PD. The positive PLC group had a significantly higher ratio of adenocarcinomas than the negative PLC group (p = 0.014). There was a significant difference in distribution of pleural factors between the positive and negative PLC groups (p < 0.001). Survival in the positive PLC group was significantly worse than in the negative PLC group (p = 0.007), especially in pathologic stage I (p = 0.001), but significantly better than in the PD group (p = 0.038). PLC status was found to be a significant independent prognostic factor in the multivariate analysis (p = 0.016). CONCLUSIONS The present study demonstrates the clinical relevance of intraoperative PLC in early stage non-small cell lung cancer. The result of intraoperative PLC should be involved in the staging system of lung cancer.
Collapse
Affiliation(s)
- Tatsuo Nakagawa
- Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan.
| | | | | | | | | | | |
Collapse
|
18
|
Satoh Y, Hoshi R, Ishikawa Y, Horai T, Okumura S, Nakagawa K. Recurrence patterns in patients with early stage non-small cell lung cancers undergoing positive pleural lavage cytology. Ann Thorac Surg 2007; 83:197-202. [PMID: 17184661 DOI: 10.1016/j.athoracsur.2006.08.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 08/10/2006] [Accepted: 08/14/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cytologic approaches such as pleural lavage cytology (PLC) are considered as possible aids to assessing prognosis of lung cancers. However, there is some controversy whether radical surgery is warranted based on the positive PLC findings with stage I non-small cell lung cancers (NSCLCs). METHODS From January 1991 to December 2002, PLC was performed before any manipulation or resection of the lung for 853 consecutive patients who had no macroscopic pleural effusion, dissemination, or diffuse adhesions and who subsequently underwent curative resection for NSCLCs. Results of PLC with reference to clinicopathologic characteristics, adjuvant therapy, 5-year survival, and recurrence patterns were analyzed. RESULTS PLC findings were positive in 41 patients (4.8%), rates being most frequent with adenosquamous carcinomas and adenocarcinomas. In the positive group, distant metastases (72%) and pleural recurrence (25%) (p = 0.0011) were often observed, and the survival rate was significantly poorer (p < 0.002), even for patients with stage I disease (p = 0.009). As adjuvant therapies in the positive group after resection, 6 patients received hypotonic cisplatin and 15 received a distilled water infusion into the pleural space. Although only 2 patients had pleural recurrence, these therapies did not improve long-term outcome. CONCLUSIONS PLC is a distinct prognostic factor for early stage lung carcinomas. Thus, we suggest that cytologic examination of PLC should be routine, even for patients with stage I NSCLCs before beginning lung resection. Moreover, curative resection, followed by adjuvant systemic therapy, could be necessary for improvement of outcome.
Collapse
Affiliation(s)
- Yukitoshi Satoh
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|
19
|
Nakayama T, Takenaka A, Uchida J, Imamura F, Higashiyama M, Kodama K. Present Status of Clinical Cytopathology of Respiratory Organs. ACTA ACUST UNITED AC 2007. [DOI: 10.2482/haigan.47.941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
20
|
Enatsu S, Yoshida J, Yokose T, Nishimura M, Nishiwaki Y, Shirakusa T, Nagai K. Pleural lavage cytology before and after lung resection in non-small cell lung cancer patients. Ann Thorac Surg 2006; 81:298-304. [PMID: 16368385 DOI: 10.1016/j.athoracsur.2005.06.073] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 06/25/2005] [Accepted: 06/27/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to analyze on a multivariate basis the prognostic significance of pre-resection and post-resection pleural lavage cytologies in surgically resected primary non-small cell lung cancer (NSCLC) patients, in relation to pathologic TNM factors in a large cohort of almost 1,200 patients. METHODS From August 1992 through March 2001, pleural lavage cytology (PLC) was performed in 1,214 NSCLC patients without pleural effusion or dissemination undergoing pulmonary resection. The cytologic evaluation was classified into three categories: negative, suggestive, and positive. To investigate the impact on patient survival, PLC results were analyzed with conventional clinicopathologic factors. RESULTS Definitive pre-resection PLC result was obtained in 1,194 patients and 38 had a positive result. The 5-year survival rates were 27% if pre-resection PLC was positive and 71% if negative. Of 1,198 patients 54 had a positive post-resection PLC result. The 5-year survival rates were 10% if post-resection PLC was positive and 73% if negative. On multivariate analysis, post-resection PLC was an independent prognostic factor as significant as established clinicopathologic factors. CONCLUSIONS Pre-resection and post-resection PLC should be recognized as an essential prognostic factor and should be performed in NSCLC patients without pleural effusion and dissemination. Post-PLC, compared with pre-PLC, had a greater and independent impact on survival and needs to be incorporated in the pathologic staging of NSCLC in the future.
Collapse
MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Large Cell/mortality
- Carcinoma, Large Cell/pathology
- Carcinoma, Large Cell/surgery
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Cohort Studies
- Female
- Humans
- Life Tables
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Lymphatic Metastasis
- Male
- Middle Aged
- Neoplasm Staging
- Pleural Effusion, Malignant/pathology
- Pneumonectomy
- Preoperative Care
- Prognosis
- Proportional Hazards Models
- Risk Factors
- Survival Analysis
- Survival Rate
- Therapeutic Irrigation
Collapse
Affiliation(s)
- Sotarou Enatsu
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
| | | | | | | | | | | | | |
Collapse
|
21
|
Stiles BM, Adusumilli PS, Bhargava A, Stanziale SF, Kim TH, Chan MK, Huq R, Wong R, Rusch VW, Fong Y. Minimally invasive localization of oncolytic herpes simplex viral therapy of metastatic pleural cancer. Cancer Gene Ther 2006; 13:53-64. [PMID: 16037824 PMCID: PMC1351128 DOI: 10.1038/sj.cgt.7700860] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Herpes simplex virus-1 (HSV-1) oncolytic therapy and gene therapy are promising treatment modalities against cancer. NV1066, one such HSV-1 virus, carries a marker gene for enhanced green fluorescent protein (EGFP). The purpose of this study was to determine whether NV1066 is cytotoxic to lung cancer and whether EGFP is a detectable marker of viral infection in vitro and in vivo. We further investigated whether EGFP expression in infected cells can be used to localize the virus and to identify small metastatic tumor foci (<1 mm) in vivo by means of minimally invasive endoscopic systems equipped with fluorescent filters. In A549 human lung cancer cells, in vitro viral replication was determined by plaque assay, cell kill by LDH release assay, and EGFP expression by flow cytometry. In vivo, A549 cells were injected into the pleural cavity of athymic mice. Mice were treated with intrapleural injection of NV1066 or saline and examined for EGFP expression in tumor deposits using a stereomicroscope or a fluorescent thoracoscopic system. NV1066 replicated in, expressed EGFP in infected cells and killed tumor cells in vitro. In vivo, treatment with intrapleural NV1066 decreased pleural disease burden, as measured by chest wall nodule counts and organ weights. EGFP was easily visualized in tumor deposits, including microscopic foci, by fluorescent thoracoscopy. NV1066 has significant oncolytic activity against a human NSCLC cell line and is effective in limiting the progression of metastatic disease in an in vivo orthotopic model. By incorporating fluorescent filters into endoscopic systems, a minimally invasive means for diagnosing small metastatic pleural deposits and localization of viral therapy for thoracic malignancies may be developed using the EGFP marker gene inserted in oncolytic herpes simplex viruses.
Collapse
Affiliation(s)
| | | | - Amit Bhargava
- From the Department of Surgery and Molecular cytology core facility
| | | | - Teresa H. Kim
- From the Department of Surgery and Molecular cytology core facility
| | - Mei-Ki Chan
- From the Department of Surgery and Molecular cytology core facility
| | - Rumana Huq
- Memorial Sloan–Kettering Cancer Center, New York, New York
| | - Richard Wong
- From the Department of Surgery and Molecular cytology core facility
| | - Valerie W. Rusch
- From the Department of Surgery and Molecular cytology core facility
| | - Yuman Fong
- From the Department of Surgery and Molecular cytology core facility
- Address for correspondence: Yuman Fong, MD, Department of Surgery, H1223, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, Phone: (212) 639-2016 Fax: (212) 639-4031, E-mail:
| |
Collapse
|
22
|
Vicidomini G, Santini M, Fiorello A, Parascandolo V, Calabrò B, Pastore V. Intraoperative Pleural Lavage: Is It a Valid Prognostic Factor in Lung Cancer? Ann Thorac Surg 2005; 79:254-7; discussion 254-7. [PMID: 15620952 DOI: 10.1016/j.athoracsur.2004.06.115] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients undergoing lung resection for non-small cell lung cancer (NSCLC), the primary TNM (tumor-regional lymph node-distant metastasis) staging system is the best prognostic factor. However, it is necessary to investigate other factors that could more accurately predict a patient's prognosis. In this study we evaluated the significance of positive intraoperative pre-resectional lavage in patients with NSCLC. METHODS We enrolled 84 patients (79 men, 5 women) aged between 36 and 81 years (mean age, 64.8 years) undergoing a major lung resection for NSCLC, with no preoperative evidence of pleural effusions. Intraoperatively, the patients were given a pre-resectional pleural lavage with physiologic saline solution. The fluid was aspirated and sent to cytology. RESULTS Pre-resectional pleural lavage was positive in 19 patients (22.6%). The lavage was positive in 7.3% in patients with early stage I disease (3/41) and 37.2% in patients with stage II/III disease. In the group of 16 patients with chest wall neoplastic involvement (T3), 9 had a positive lavage (56.2%; p = 0.05). No significant correlation was found between positive lavage and nodal status, visceral pleural involvement, or histologic findings. Patients with malignant cells in the pre-resectional lavage had a significantly shorter survival than patients with a negative lavage (p = 0.025). CONCLUSIONS A positive cytology finding of intraoperative pre-resectional pleural lavage could be an important prognostic factor in patients undergoing major lung resection for NSCLC. Patients with a positive lavage should be upstaged. However, larger series are needed to define accurately the role of this technique in early stage lung cancer.
Collapse
|
23
|
Higashiyama M, Kodama K, Takami K, Higaki N, Nakayama T, Yokouchi H. Malignant status at surgical margin of limited-resected non–small cell lung cancer: a crucial finding for predicting local relapse: Reply to the Editor. J Thorac Cardiovasc Surg 2003. [DOI: 10.1016/s0022-5223(03)00687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
24
|
Ishikawa O, Wada H, Ohigashi H, Doki Y, Yokoyama S, Noura S, Yamada T, Sasaki Y, Imaoka S, Kasugai T, Matsunaga T, Takenaka A, Nakaizumi A. Postoperative cytology for drained fluid from the pancreatic bed after "curative" resection of pancreatic cancers: does it predict both the patient's prognosis and the site of cancer recurrence? Ann Surg 2003; 238:103-10. [PMID: 12832972 PMCID: PMC1422659 DOI: 10.1097/01.sla.0000074982.51763.d6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the postoperative cytology of drained fluid from the pancreatic bed as a predictive indicator of local recurrence after curative (R0) resection of pancreatic cancer. SUMMARY BACKGROUND DATA The pancreatic bed offers a common site of cancer recurrence (local recurrence), even after curative (R0) resection is performed for pancreatic cancer. If local recurrence is thereby predicted precisely, soon after surgery, we have a chance to treat it by adding radiation or some other locoregional therapy before it can grow or spread beyond the pancreatic bed. However, there have been no previous reports of cytology performed on the drained fluid after pancreatectomy. METHODS This study includes 94 patients who had shown negative results in the peritoneal washing cytology before resection and subsequently received pancreatectomies for pancreatic tumors. They consisted of 12 benign tumors, 17 noninvasive or minimally invasive carcinomas and 65 invasive ductal carcinomas (R0 = 58; R1/2 = 7). Postoperatively, the drained fluid from the pancreatic bed was collected for 24 hours and used for cytologic examination. The cytologic results were examined in association with the histopathology of the resected tumor, patient's survival, and mode of cancer recurrence, including local recurrence. RESULTS Patients with benign tumors or noninvasive/minimally invasive carcinomas had negative result in cytology, and none of them have died of local recurrence (limited to the pancreatic bed) to date. However, patients with invasive ductal carcinoma revealed higher cytology-positive rates: 28% (16/58) in curative (R0) resection; and 71% (5/7) in noncurative (R1/2) resection. Among 58 patients with R0 resection, the 3-year survival rate was 14% in 16 cytology-positive patients and 55% in 42 cytology-negative patients (P < 0.05). The 3-year cumulative rate of local recurrence was 85% and 23%, respectively (P < 0.05). Compared with other histopathologic parameters obtained from the resected specimens, the drain cytology was more specific in predicting the subsequent development of local recurrence. CONCLUSIONS Drain-cytology was a quick examination that enabled us to specifically indicate both minute residual cancer and subsequent development of local recurrence even after R0 resection of pancreatic cancer.
Collapse
Affiliation(s)
- Osamu Ishikawa
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-Nakamichi, 1-chome, Higashinari-ku, Osaka 537-8511, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Higashiyama M, Kodama K, Takami K, Higaki N, Nakayama T, Yokouchi H. Intraoperative lavage cytologic analysis of surgical margins in patients undergoing limited surgery for lung cancer. J Thorac Cardiovasc Surg 2003; 125:101-7. [PMID: 12538991 DOI: 10.1067/mtc.2003.92] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND One of the unfavorable recurrent patterns after limited surgery for lung cancer is local failure, especially at the surgical margin in the pulmonary parenchyma. To prevent this failure, we preliminarily introduced a novel intraoperative lavage cytologic technique to check surgical margin status for limited surgery. In this study we analyzed the clinical utility of this technique with a larger number of patients under long-term follow-up. METHODS A total 112 consecutive lung cancer lesions prospectively treated by limited surgery with the intraoperative lavage cytologic technique between October 1997 and August 2000 were reviewed through a median follow-up period of 27 months. RESULTS Eleven lesions (10%) showed cytologically positive results in the attempted surgery on the surgical margin. The positive result rate was significantly higher for lesions with more advanced stage, compromised indication, incurability, and larger size. Surgical modes were converted intraoperatively for 4 lesions; in the other 7 lesions no conversion was performed because of certain disadvantages. Local recurrence in the surgical margin occurred in a total of 4 lesions, including 3 for which the operative mode was unconverted and 1 lesion with cytologically unknown status of the surgical margin that had the mode converted, whereas there were no local recurrences in the surgical margins among the lesions with final cytologically negative results. CONCLUSION Cytologically negative results of examination of the surgical margin by the technique of intraoperative lavage cytologic in limited surgery for lung cancer may be predict lack of local recurrence in the surgical margin. This intraoperative cytologic technique is clinically useful in checking for complete resection of this primary disease.
Collapse
Affiliation(s)
- Masahiko Higashiyama
- Departments of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Suita Municipal Hospital, Osaka, Japan.
| | | | | | | | | | | |
Collapse
|
26
|
Jiao X, Krasna MJ. Clinical significance of micrometastasis in lung and esophageal cancer: a new paradigm in thoracic oncology. Ann Thorac Surg 2002; 74:278-84. [PMID: 12118789 DOI: 10.1016/s0003-4975(01)03376-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the past decade, detection of micrometastatic disease in different clinical samples including pleural lavage, lymph node, bone marrow, and blood has become a rapidly growing area of interest in research of non-small cell lung cancer and esophageal cancer. The results of these studies support the concept that, just as in many other solid malignancies, systemic spread may happen at an early stage in non-small cell lung cancer and esophageal cancer. Such systemic spread is often occult (micrometastases) at the time of primary diagnosis, which may have adverse effects on survival. Improved staging can be expected with information on micrometastases, and a subgroup of patients who will benefit most from adjuvant therapy might be identified. Although reliable and standard methods need to be developed before detection of micrometastasis is incorporated in the routine clinical practice, we suggest that it be considered an important correlate in clinical trials in non-small cell lung cancer and esophageal cancer.
Collapse
Affiliation(s)
- Xiaolong Jiao
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore 21201, USA.
| | | |
Collapse
|
27
|
Sawabata N, Matsumura A, Motohiro A, Osaka Y, Gennga K, Fukai S, Mori T. Malignant minor pleural effusion detected on thoracotomy for patients with non-small cell lung cancer: is tumor resection beneficial for prognosis? Ann Thorac Surg 2002; 73:412-5. [PMID: 11845851 DOI: 10.1016/s0003-4975(01)03426-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study attempts to clarify the benefit of surgery for non-small cell lung cancer (NSCLC) with malignant minor pleural effusion that is detected at thoracotomy. METHODS Records of surgical patients with NSCLC were reviewed, with a definition of minor pleural effusion as less than 300 mL. The patients were divided into three groups as follows: (1) group C consisted of patients who underwent grossly complete resection; group I, patients with incomplete tumor resection; and group E, patients who underwent exploratory thoracotomy only. RESULTS There were 196 patients who had minor pleural effusion; of these, 96 (46%) underwent an examination to define the malignancy status of pleural effusion after surgery. In 43 patients (45%), the effusion was found to be malignant. The median survival time and 5-year survival rate, respectively, were 13 months and 9% for group C (n = 11); 34 months and 10% for group I (n = 14; p = 0.3); and 17 months and 0% for group E (n = 18; p = 0.8). CONCLUSIONS Tumor resection is not beneficial for the survival of patients with NSCLC who have a minor malignant pleural effusion.
Collapse
Affiliation(s)
- Noriyoshi Sawabata
- Division of Surgery, Toneyama National Hospital, Toyonaka, Osaka, Japan.
| | | | | | | | | | | | | |
Collapse
|
28
|
Doki Y, Kabuto T, Ishikawa O, Ohigashi H, Sasaki Y, Yamada T, Hiratsuka M, Miyashiro I, Kameyama M, Murata K, Imaoka S, Yasuda T, Nakaizumi A, Takenaka A. Does pleural lavage cytology before thoracic closure predict both patient's prognosis and site of cancer recurrence after resection of esophageal cancer? Surgery 2001; 130:792-7. [PMID: 11685188 DOI: 10.1067/msy.2001.117195] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Operative manipulation occasionally exfoliates and spreads cancer cells in the surgical field, and it is a matter of concern whether the exfoliated cancer cells actually affect the patient's prognosis and sites of cancer recurrence. METHODS In 240 patients with esophageal cancers, lavage cytology (LC) of the right pleural cavity was performed before and after esophageal resection combined with regional lymphadenectomy. The cytologic results were compared with the pathologic factors associated with cancer extension, postoperative survival, and cause of surgical failure. RESULTS Only 3 patients (1.3%) were LC positive before resection. Of the 237 LC-negative patients, LC was also negative after resection in 215 patients (90.7%) (LC-/-), but LC became positive after resection in 22 patients (9.3%) (LC-/+). The 3-year survival rate was 0% in the LC-/+ group versus 65% in the LC-/- group, and the median survival rates were 10.9 months and 25.0 months, respectively (P <.0001). Multivariate analysis revealed that LC-/+ was an independent prognostic factor (P =.0331), along with nodal involvement and depth of cancer invasion. However, there were no significant differences in the sites of cancer recurrence between the 2 groups. Only 1 patient was found to develop the first recurrence in the pleural cavity. The LC-/+ group had a higher incidence of bulky lymph-node metastasis (P =.0009). CONCLUSIONS Pleural LC after resection of esophageal cancer seems to be a prognostic indicator of overall recurrence, but not necessarily in the pleural cavity. Patients with a positive LC after resection may benefit most by effective systemic adjuvant chemotherapy.
Collapse
Affiliation(s)
- Y Doki
- Departments of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Higashiyama M, Kodama K, Yokouchi H, Takami K, Nakayama T, Horai T. Clinical value of pleural lavage cytological positivity in lung cancer patients without intraoperative malignant pleuritis. Recurrent pattern based on semiquantitative analysis of tumor cells in pleural lavage. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:611-7. [PMID: 11080947 DOI: 10.1007/bf03218215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES We recently developed pleural lavage cytology for lung cancer patients without intraoperative signs of malignant pleuritis (Ann Surg Oncol, 4: 409, 1997). We analyzed recurrent patterns in pleural lavage cytology-positive lung cancer patients without intraoperative signs of malignant pleuritis based on semiquantitative evaluation of tumor cell clusters in pleural lavage solution. METHODS Between December 1987 and December 1998, pleural lavage cytology-positive results after thoracotomy were obtained in 97 cases of lung cancer despite the lack of evidence of malignant pleuritis. Based on semiquantitative evaluation of the mean number of tumor cell clusters per slide in pleural lavage solution, patients were classified as Type I, in whom the mean number of clusters was < 1; Type II, in whom clusters numbered 1-10; and Type III, in whom clusters exceeded 10. RESULTS Type I patients numbered 37, Type II 40, and Type III 20. By September 1999, pleural recurrence had occurred in 17 patients (18%)--2(5%) Type I, 4 (10%) Type II, and 11 (55%) Type III. The incidence of pleural recurrence was significantly higher for Type III patients, i.e., 5 of 11 Type III patients with pleural recurrence showed no sign of distant metastasis. In contrast, the main recurrent patterns in the other 2 groups were extrathoracic, nodal, and/or intrapulmonary. CONCLUSIONS The semiquantitative evaluation of tumor cell clusters in pleural lavage cytology-positive patients provided useful information on postoperative recurrence. Since Type III patients are at high-risk for pleural recurrence, postoperative therapy targeting local control should be conducted in such patients.
Collapse
Affiliation(s)
- M Higashiyama
- Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan
| | | | | | | | | | | |
Collapse
|
30
|
Higashiyama M, Kodama K, Yokouchi H, Takami K, Nakayama T, Horai T. A novel test of the surgical margin in patients with lung cancer undergoing limited surgery: lavage cytologic technique. J Thorac Cardiovasc Surg 2000; 120:412-3. [PMID: 10917965 DOI: 10.1067/mtc.2000.107343] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M Higashiyama
- Departments of Thoracic Surgery and Respiratory Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinariku, Osaka, Japan.
| | | | | | | | | | | |
Collapse
|
31
|
Dresler CM, Fratelli C, Babb J. Prognostic value of positive pleural lavage in patients with lung cancer resection. Ann Thorac Surg 1999; 67:1435-9. [PMID: 10355426 DOI: 10.1016/s0003-4975(99)00220-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite an early stage, lung cancer patients often have a poor survival, suggesting inaccurate staging. A pleural lavage demonstrating malignant cells at the time of operation may predict a poorer survival, particularly in patients with otherwise early disease. METHODS Patients, with no preoperative evidence of pleural effusions and undergoing a surgical resection with curative intent, had a preresectional and postresectional lavage to be evaluated by cytology. RESULTS Fourteen percent of patients with stage I disease had malignant cells in their preresectional lavage and had a significantly shorter survival than stage I patients with a negative lavage. Positivity of preresectional lavage was not correlated with nodal status, pleural or lymphatic involvement, or histologic findings. CONCLUSIONS Preoperative pleural lavage should become a standard technique intraoperatively to better characterize and stage patients undergoing lung cancer resections. Patients with malignant cells in their preoperative lavage should be upstaged.
Collapse
Affiliation(s)
- C M Dresler
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | | |
Collapse
|