E. E. McGillivray1, E. O’Halloran1, M. Hill1, S. Murthy1, K. Liang1, C. Mayemura1, N. Goel1, A. Karachristos1, J. Farma1, J. Hoffman1, S. S. Reddy1 1Fox Chase Cancer Center,Department Of Surgical Oncology,Philadelphia, PA, USA
Introduction: Positive cytology from peritoneal washings obtained at diagnostic laparoscopy prior to potential resection of pancreatic cancer is associated with a poor prognosis, equivalent to metastatic (M1) disease. We examine our experience with pancreatic cancer patients who underwent diagnostic laparoscopy in an attempt to predict who would have malignant cells found on peritoneal cytology.
Methods: We conducted a retrospective chart review of all patients that underwent pancreatoduodenectomy, distal pancreatectomy, or total pancreatectomy for pancreatic adenocarcinoma at a tertiary care institution from 2000-2017. Only patients that had peritoneal washings were included. Total neoadjuvant therapy (TNT) was defined as chemotherapy followed by chemoradiation. Demographic and preoperative clinical data were collected and reviewed. Stepwise backward-selection estimation for logistic regression was performed to identify predictors of positive cytology in the cohort.
Results: Three hundred patients underwent pancreatic resection for adenocarcinoma in the study period. Twenty four patients (8.0%) had positive cytology. Age at diagnosis, sex, race, smoking status, preoperative comorbidities such as diabetes, heart disease, and renal failure, initial clinical stage, initial CA19-9, and undergoing a preoperative biliary drainage procedure were not predictive of positive cytology. Receiving preoperative neoadjuvant chemotherapy or chemoradiotherapy that was not TNT was associated with increased odds of positive cytology (OR 3.54, 95% CI 1.2-10.6, p = 0.023). Locally advanced disease on their initial computed tomography study also portended an increased odds of positive cytology, with an associated odds ratio of 8.1 (95% CI 2.5-25.9, p < 0.001).
Conclusion: Patients who underwent preoperative systemic therapy but did not receive total neoadjuvant therapy, and those with locally advanced disease on initial imaging, had greater odds of having positive peritoneal cytology at diagnostic laparoscopy.