Intraoperative dissemination during gastrectomy for gastric cancer associated with serosal invasion

Purpose Free cancer cells shed from the serosal surface of gastric cancer result in peritoneal dissemination. The aim of this study was to clarify the extent of tumor cell implantation due to surgical manipulation during gastrectomy. Methods The participants comprised 34 patients who underwent curative gastrectomy for gastric cancer with macroscopic serosal invasion. Two types of cytology were obtained from each patient: (1) cytology from the wound dressing material that covered the serosal invasion area during the operation (Covering Cy), and (2) cytology of the intraperitoneal wash samples (Lavage Cy). Result Thirteen patients showed no serosal invasion histopathologically, and all of these patients had negative results for both Lavage Cy and Covering Cy. Among the 21 patients with histopathologically confirmed serosal invasion, six had positive results for both Lavage Cy and Covering Cy, three showed positive findings for Covering Cy alone, one had positive Lavage Cy alone and 11 patients had negative results for both Lavage Cy and Covering Cy. Disseminated recurrence developed in 10 patients. Seven of the nine patients with positive Covering Cy developed disseminated recurrence, compared to three of 12 patients with negative Covering Cy. Positive Covering Cy findings were significantly associated with disseminated recurrence (p < 0.05). Conclusion We demonstrated that the intraoperative dissemination of gastric cancer can occur during gastrectomy.