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.
(Surgery 2001;130:792-7.)
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Article info
Publication history
Accepted:
May 5,
2001
Footnotes
*Reprint requests: Yuichiro Doki, MD, Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, 537-8511 Osaka, Japan.
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
