A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer

Background There is lack of uniformity in the utilization of peritoneal cytology in gastric cancer management. the identification of intraperitoneal free cancer cells (IFCCs) is believed to confer poor prognosis. However, while some of these patients are palliated, others may undergo more aggressive therapies. in this review, we aimed to identify and synthesize findings on the use of peritoneal cytology in predicting peritoneal recurrence and overall survival in curative gastric cancer patients.Methods Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 31, 2009. We determined the accuracy, sensitivity, and specificity of peritoneal cytology in predicting peritoneal recurrence based on four techniques-conventional cytology, immunoassay, immunohistochemistry, and reverse transcriptase-polymerase chain reaction. Recurrence rates and overall survival rates for curative patients were determined, based on positivity or negativity for IFCCs.Results Twenty-eight articles were included. All four techniques showed wide variations in accuracy, sensitivity, and specificity in predicting peritoneal recurrence. Recurrence rates for patients positive for IFCCs ranged from 11.1 to 100%, while those negative for IFCCs had recurrence rates of 0-51%. Overall survival was significantly reduced for patients with positive IFCCs. Short follow-up periods and possible duplication of results may limit result interpretation.Conclusion the presence of IFCCs appears to increase the risk of peritoneal recurrence and is associated with worse overall survival in gastric cancer patients. Further incorporation of peritoneal cytology in clinical decision-making in gastric cancer depends on the development of a consistently accurate and rapid IFCC detection method.Canadian Cancer SocietyOntario Ministry of Health and Long-Term CareUniv Toronto, Dept Surg, Toronto, ON, CanadaSunnybrook Hlth Sci Ctr, Sunnybrook Res Inst, Toronto, ON M4N 3M5, CanadaUniversidade Federal de São Paulo, Dept Surg, São Paulo, BrazilDalhousie Univ, Dept Surg, Halifax, NS B3H 4H2, CanadaQueens Univ, Dept Community Hlth & Epidemiol, Kingston, ON, CanadaSunnybrook Hlth Sci Ctr, Dept Anat Pathol, Toronto, ON M4N 3M5, CanadaUniv Toronto, Div Surg Oncol, Sunnybrook Hlth Sci Ctr, Odette Canc Ctr, Toronto, ON, CanadaUniversidade Federal de São Paulo, Dept Surg, São Paulo, BrazilCanadian Cancer Society: 019325Web of Scienc

A systematic review of the accuracy and indications for diagnostic laparoscopy prior to curative-intent resection of gastric cancer

Background Despite improved preoperative imaging techniques, patients with incurable or unresectable gastric cancer are still subjected to non-therapeutic laparotomy. Diagnostic laparoscopy (DL) has been advocated by some to be essential in decision-making in gastric cancer. We aimed to identify and synthesize findings on the value of DL for patients with gastric cancer, in this era of improved preoperative imaging.Methods Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 31, 2009. We calculated the change in management and avoidance of laparotomy based on the addition of DL and laparoscopic ultrasound (LUS). the accuracy, agreement (kappa), sensitivity, and specificity of DL in assessing tumor extent, nodal involvement, and the presence of metastases with respect to the gold standard (pathology) were also calculated.Results Twenty-one articles were included. DL showed moderate to substantial agreement with final pathology for T stage, but only fair agreement for N stage. for M staging, DL had an overall accuracy, sensitivity, and specificity ranging from 85-98.9%, 64.3-94%, and 80-100%, respectively. the use of DL altered treatment in 8.5-59.6% of cases, avoiding laparotomy in 8.5-43.8% of cases. LUS provided additional benefit in 5.8-7.2% of cases.Conclusions Despite evolving preoperative imaging techniques, diagnostic laparoscopy continues to be of substantial value in staging patients with gastric cancer and in avoiding unnecessary laparotomy. the current data support DL for all patients with advanced gastric cancer.Canadian Cancer SocietyOntario Ministry of Health and Long-Term CareHanna Family Chair in Surgical OncologyUniv Toronto, Dept Surg, Toronto, ON, CanadaSunnybrook Hlth Sci Ctr, Sunnybrook Res Inst, Toronto, ON M4N 3M5, CanadaUniversidade Federal de São Paulo, Dept Surg, São Paulo, BrazilDalhousie Univ, Dept Surg, Halifax, NS B3H 4H2, CanadaQueens Univ, Dept Community Hlth & Epidemiol, Kingston, ON, CanadaUniv Toronto, Sunnybrook Hlth Sci Ctr, Div Surg Oncol, Odette Canc Ctr, Toronto, ON, CanadaUniversidade Federal de São Paulo, Dept Surg, São Paulo, BrazilCanadian Cancer Society: 019325Web of Scienc

Evidence-Based PET for Abdominal and Pelvic Tumours

Evidence-based data about the usefulness of positron emission tomography (PET) and hybrid imaging methods (PET/CT and PET/MRI) in abdominal and pelvic tumours have been collected and discussed in this chapter. These data were divided in three sections: (1) gastrointestinal tumours, (2) uro-genital tumours, (3) gynaecological tumours. Several pooled data (diagnostic and prognostic data), clinical settings (e.g. staging, restaging, treatment evaluation) and radiotracers as fluorine-18 fluorodeoxyglucose (18F-FDG), radiolabelled choline and prostate-specific membrane antigen (PSMA) were considered

Sliding droplets of Xanthan solutions: A joint experimental and numerical study

We have investigated the sliding of droplets made of solutions of Xanthan, a stiff rodlike polysaccharide exhibiting a non-Newtonian behavior, notably characterized by a shear thinning viscosity accompanied by the emergence of normal stress difference as the polymer concentration is increased. These experimental results are quantitatively compared with those of Newtonian fluids (water). The impact of the non-Newtonian behavior on the sliding process was shown through the relation between the average dimensionless velocity (i.e. the capillary number) and the dimensionless volume forces (i.e. the Bond number). To this aim, it is needed to define operative strategies to compute the capillary number for the shear thinning fluids and compare with the corresponding Newtonian case. The resulting capillary number for the Xanthan solutions scales linearly with the Bond number at small inclinations, as well known for Newtonian fluids, while it shows a plateau as the Bond number is increased. Experimental data were complemented with lattice Boltzmann numerical simulations of sliding droplets, aimed to disentangle the specific contribution of shear thinning and elastic effects on the sliding behavior. In particular the deviation from the linear (Newtonian) trend is more likely attributed to the emergence of normal stresses inside the non-Newtonian droplet

Multivisceral resection for gastric cancer: a systematic review

Background: The overall prognosis and survival of patients with advanced gastric cancer is generally poor. One of the most powerful predictors of outcomes in gastric cancer surgery is an R0 resection. However, the extent of the required surgical resection and the additional benefit of multivisceral resection (MVR) are controversial . Methods: Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 31, 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers. Results: Seventeen studies were included in this review. Among the 1343 patients who underwent MVR, overall complication rates ranged from 11.8 to 90.5%. Perioperative mortality was found to be 0-15%. Pathological T4 disease was confirmed in 28.8-89% of patients. R0 resection and extent of nodal involvement were important predictors of survival in patients undergoing MVR. Patient outcomes may also be affected by the number of organs resected. Conclusions: Gastrectomy with MVR can be safely pursued in patients with locally advanced gastric cancer to achieve an R0 resection. MVR may not be beneficial in patients with extensive nodal disease