Peritoneal cytology in patients with potentially resectable adenocarcinoma of the pancreas

The prognostic significance of malignant cells in the peritoneal washings of patients with pancreatic adenocarcinoma remains poorly defined. Prior reports suggest that positive peritoneal cytology (PPC) is associated with advanced disease and reduced survival. To determine the prognostic value of PPC in patients with pancreatic cancer, we retrospectively reviewed our database between July 1987 and September 2002 and identified 168 patients who had undergone exploration for potentially resectable pancreatic cancer with peritoneal washings performed at the time of exploration. One hundred thirty-five patients underwent resection; 33 were considered unresectable. PPC was reported for 27 patients (16.1%): 13 (9.6%) in the resected and 14 (42.4%) in the unresected group. Median time to macroscopically detected recurrence in the resected group was not significantly different in the PPC versus negative peritoneal cytology (NPC) patients (10 vs 12 months, P = 0.46). Median overall survival of patients with PPC versus NPC approached, but did not reach, significance (15 vs 19 months, P = 0.055). Peritoneal cytology status was not associated with administration of chemoradiation, margin status, antecedent fine-needle aspiration, stage, or site of recurrence. These data suggest that malignant cells in peritoneal washings of patients with potentially resectable pancreatic adenocarcinoma should not preclude resection. Long-term survival may be achieved, therefore aggressive treatment should strongly be considered.