Prognostic role of peritoneal lavage cytology: Proposal for staging laparoscopy criteria in biliary tract cancer.

BACKGROUND

The role of radical resection for CY-positive BTC remains controversial and needs reassessment in the era of effective multi-agent chemotherapy. To evaluate the clinical significance of peritoneal lavage cytology (CY) in the perioperative management of biliary tract cancer (BTC) and propose novel staging laparoscopy (SL) criteria.

METHODS

We reviewed the medical records of 782 patients with BTC, excluding those with cancer of the papilla of Vater. Patients were classified based on CY and metastatic (M) status.

RESULTS

Among 782 BTC patients, 38 (4.9 %) were CY-positive. Patients were categorized as follows: CY1M0 resected group (n = 10, 1.3 %), CY0M0 resected group (n = 637, 81.5 %), M1 resected group (n = 50, 6.4 %), and M1 unresected group (n = 70, 9.0 %). The postoperative median overall survival was 58.8, 19.5, 19.3, and 13.5 months respectively (p < 0.001). Postoperative recurrence occurred in 9 patients (90.0 %), 306 patients (48.0 %), and 43 patients (86.0 %) in the CY1M0, CY0M0, and M1 resected group, respectively. Multivariate analysis of pre- and intra-operative factors revealed that CY positivity was independently associated with postoperative recurrence (odds ratio, 7.18; 95 % confidence interval, 1.28-134.83; p = 0.022), along with other significant factors. A combination of cT3/T4 and cN-positive status was the good indicator of staging laparoscopy, achieving a detection rate of 28.8 % and accuracy of 85.2 %.

CONCLUSION

CY positivity is associated with postoperative recurrence and poor prognosis and can be considered equivalent to M1 status. Staging laparoscopy may be indicated for patients with a combination of cT3/T4 and cN positivity.