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World J Gastrointest Surg. May 27, 2013; 5(5): 135-137
Published online May 27, 2013. doi: 10.4240/wjgs.v5.i5.135
Prognosis and treatment of patients with positive peritoneal cytology in advanced gastric cancer
Francesco Frattini, Stefano Rausei, Corrado Chiappa, Francesca Rovera, Luigi Boni, Gianlorenzo Dionigi
Francesco Frattini, Stefano Rausei, Corrado Chiappa, Francesca Rovera, Luigi Boni, Gianlorenzo Dionigi, Department of Surgical Sciences, University of Insubria School of Medicine, 21100 Varese, Italy
Author contributions: Frattini F collected the materials and wrote the manuscript; Rausei S, Chiappa C and Rovera F discussed the topic; Boni L and Dionigi G supervised the publication of this commentary.
Correspondence to: Francesco Frattini, MD, Department of Surgical Sciences, University of Insubria School of Medicine, Viale L. Borri 57, 21100 Varese, Italy. francescofrattini@virgilio.it
Telephone: +39-33-2278867 Fax: +39-33-2393630
Received: November 11, 2012
Revised: April 2, 2013
Accepted: April 18, 2013
Published online: May 27, 2013
Abstract

Positive peritoneal cytology in gastric cancer is classified as M1 disease by the 7th Edition of American Joint Committee on Cancer staging system. With the introduction of laparoscopy and peritoneal washing cytology in the staging of gastric cancer a new category of patients has been identified. These are patients with no macroscopic peritoneal metastases but with peritoneal cytology positive (P0C1). Prognosis and treatment of such patients represent a controversial issue. We evaluate the state of the art of staging system in gastric cancer and discuss standardisation in staging and treatment procedures. There is still a lack of uniformity in the use of laparoscopy with peritoneal cytology in clinical decision making and in the surgical treatment for gastric cancer. Survival of this patient subset remains poor. Multimodal therapies and new therapeutic strategies are required to improve the survival of these patients.

Keywords: Advanced gastric cancer, Peritoneal washing cytology, Staging laparoscopy, Reverse transcription-polymerase chain reaction

Core tip: Gastric cancer staging is still matter of debate as it evolves along with introduction of new diagnostic tools. Use of laparoscopy and washing cytology in gastric cancer staging has identified a particular category of patients with no macroscopic peritoneal disease but with positive peritoneal cytology. Prognosis and management of such patients still remains a controversial issue.