Does pleural lavage cytology before thoracic closure predict both patient's prognosis and site of cancer recurrence after resection of esophageal cancer?

Background. Operative manipulation occasionally exfoliates and spreads cancer cells in the surgical field, and it is a matter of concern whether the exfoliated cancer cells actually affect the patient's prognosis and sites Of cancer recurrence. Methods. In 240 patients with esophageal cancers, lavage cytology (LC) of the right pleural cavity was performed before and after esophageal resection combined with regional lymphadenectomy, The cytologic results were compared with the pathologic factors associated with cancer extension, postoperative survival, and cause of surgical failure. Results. Only 3 patients (1.3%) were LC Positive before resection. Of the 237 LC-negative patients, LC was also negative after resection in 215 patients (90.7%) (LC-/-), but LC became positive after resection in 22 patients (9.3%) (LC-/+). The 3-year survival rate was 0% in the LC-/+ group versus 65% in the LC-/- group, and the median survival rates were 10.9 months and 25.0 months, respectively (P < .0001). Multivariate analysis revealed that LC-/+ was an independent prognostic factor (P = .0331), along with nodal involvement and depth of cancer invasion. However, there were no significant differences in the sites Of cancer recurrence between the 2 groups. Only 1 patient was found to develop the first recurrence in the pleural cavity. The LC-/+ group had a higher incidence of bulky lymph-node metastasis (P = .0009). Conclusions. Pleural LC after resection of esophageal cancer seems to be a prognostic indicator of overall recurrence., but not necessarily in the pleural cavity. Patients with a positive LC after resection may benefit most by effective systemic adjuvant chemotherapy.