Implications of peritoneal cytology for pancreatic cancer management

Martin A. Makary, Andrew L. Warshaw, Barbara A. Centeno, Christopher G. Willett, David W. Rattner, Carlos Fernández-Del Castillo

Research output: Contribution to journalArticle

Abstract

Objective: To assess the implications of positive cytology for malignant cells (positive results) from peritoneal washings in the management of patients with pancreatic cancer. Design: Retrospective cohort study. Setting: Referral practice in a university hospital. Patients: A total of 32 consecutive pancreatic cancer patients with positive results from peritoneal washings during a 4-year period, 17 with visible biopsy-proven intraabdominal metastases at the time of laparoscopy or laparotomy and 15 without visible metastases. A treatment-matched control group of 30 patients was randomly selected from a group of 105 patients with negative cytology for malignant cells (negative results) from peritoneal fluid cytology. Interventions: Eight of 17 patients with visible metastases underwent treatment with chemotherapy, radiation, or both 13 of the 15 patients with no visible metastases underwent further treatment, including pancreatic resection in 2 patients and external beam radiation in 13 patients (3 with intraoperative radiation therapy). Main Outcome Measures: Time to metastases and mortality. Results: Median survival among patients with and without visible metastasis was 7.8 months and 8.6 months, respectively (P=.95), despite the fact that patients without visible metastases received more treatment. Patients without visible metastases at, presentation were found to have metastatic disease as documented by computed tomographic scan or subsequent laparotomy at a median time of 2.9 months. The survival of treatment-matched patients with negative cytology was significantly longer (median, 13.5 months; P=.04). Conclusions: Pancreatic cancer patients with peritoneal micrometastases have a dismal outcome even without macroscopic metastases. Since these patients do not benefit from local therapy, the finding of a positive result from peritoneal-fluid cytologic testing contraindicates further irradiation or surgery, except for specific complications.

Original languageEnglish (US)
Pages (from-to)361-365
Number of pages5
JournalArchives of surgery
Volume133
Issue number4
DOIs
StatePublished - Apr 1 1998
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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    Makary, M. A., Warshaw, A. L., Centeno, B. A., Willett, C. G., Rattner, D. W., & Fernández-Del Castillo, C. (1998). Implications of peritoneal cytology for pancreatic cancer management. Archives of surgery, 133(4), 361-365. https://doi.org/10.1001/archsurg.133.4.361