Conventional peritoneal cytology lacks the prognostic significance of detecting local or peritoneal recurrence in colorectal cancer: An Egyptian experience

Mohamed Shalaby; Tarek S El Baradie; Mohamed Salama; Hebat A M Shaaban; Rasha M Allam; Ehab O A Hafiz; Mohamed Aly Abdelhamed; Amr Attia

doi:10.1002/jgh3.12482

Conventional peritoneal cytology lacks the prognostic significance of detecting local or peritoneal recurrence in colorectal cancer: An Egyptian experience

JGH Open. 2020 Dec 29;5(2):264-272. doi: 10.1002/jgh3.12482. eCollection 2021 Feb.

Authors

Mohamed Shalaby¹, Tarek S El Baradie¹, Mohamed Salama¹, Hebat A M Shaaban², Rasha M Allam³, Ehab O A Hafiz⁴, Mohamed Aly Abdelhamed¹, Amr Attia¹

Affiliations

¹ Surgery Department National Cancer Institute, Cairo University Cairo Egypt.
² Department of Pathology National Cancer Institute, Cairo University Cairo Egypt.
³ Biostatistics and Cancer Epidemiology Department National Cancer Institute, Cairo University Cairo Egypt.
⁴ Clinical Laboratory Research Department Theodor Bilharz Research Institute (TBRI) Giza Egypt.

Abstract

Background and aim: Colorectal cancer (CRC) accounts for over 8% of all deaths each year, with 1.2 million new cases diagnosed annually worldwide. It represents the seventh most common cancer in Egypt. Early detection of peritoneal metastasis is a major challenge in such cases. It helps with the decision of the immediate application of intraperitoneal chemotherapy after resection. Meta-analysis studies reported contrast evidence for a possible prognostic role of intraperitoneal free cancer cells (IPCCs) in peritoneal recurrence and survival after curative resection. In this work, we aim to evaluate the prevalence and impact of detecting free malignant cells in peritoneal fluid on survival and local recurrence and to estimate the incidence of peritoneal carcinomatosis (PC) during follow up.

Methods: Design: This was a prospective cohort study. Settings: From June 2016 to December 2018, samples were collected from 104 patients who underwent abdominal surgery for colorectal cancer in the Egyptian National Cancer Institute. A total of 96 Egyptian CRC patients who underwent curative resection were enrolled. Intraoperative peritoneal lavage was performed to detect IPCC by conventional cytology. Patients with no residual tumor after surgery and no evidence of PC were followed up for a median 14 months. The cumulative 12-month overall survival rate for patients with IPCC was 100% versus 86% for patients with negative cytology.

Results: Our results demonstrated that the prevalence of IPCC in the peritoneal lavage was 11.5%. Peritoneal and local recurrence occurred at a higher rate in patients with cytology positive lavage (9.1% vs 6.3% and 9.1% vs 3.8%, respectively), although this was statistically insignificant. Distant metastasis occurred significantly in patients with positive cytology (45.5% vs 8.9%) with P-value <0.001.The conventional cytology technique has a high specificity but less sensitivity.

Conclusions: The presence of IPCC using conventional cytology was not an independent prognostic factor for the development of PC or survival.

Keywords: colorectal cancer; cytology; peritoneal; recurrence.