Study on Carcinoma Stomach with Special Emphasis on the Significance of Peritoneal Wash Cytology during Laproscopy and Laparotomy in unseen Metastasis

BACKGROUND: Carcinoma stomach is one of the leading causes of cancer related deaths. The potentially curative treatment for gastric adenocarcinoma is a complete margin negative (R0) resection. Hence, surgery forms the mainstay of treatment of carcinoma stomach. The commonest pattern of gastric cancer relapse is peritoneal metastasis which is the foremost cause of death even after curative resection is done. Studies have shown that despite radiological findings ruled out metastasis, staging laparoscopy contributes substantially in upstaging the disease. Also positive peritoneal wash cytology during laparoscopy or laparotomy & proceed indicates peritoneal micromets and patients with positive peritoneal wash cytology has been regarded as stage IV disease and should be treated with palliative intent. OBJECTIVES: 1. To study the Age & Sex incidence of CA Stomach. 2. To study the presenting complaints and mode of presentation of CA stomach. 3. To categorize the anatomical site of tumor. 4. To classify the patients into curative or palliative group. 5. To study the significance of peritoneal lavage cytology during laparoscopy/laparotomy procedure. METHODS: The study was conducted on 22 patients diagnosed with adenocarcinoma of the stomach who were admitted in Government Stanley Medical College between June 2015 to September 2016. Patients admitted with gastric malignancy who satisfied the inclusion and exclusion criteria were included in the study. Upper GI scopy and CECT Abdomen were done as a routine to confirm the disease and to rule out metastasis respectively. Patients without obvious metastasis in CECT Abdomen were subjected to either staging laparoscopy or laparotomy and proceed. During diagnostic laparoscopy, patients with obvious peritoneal and liver mets were noted and analyzed. These patients were excluded from taking peritoneal wash cytology. Remaining patients with no evidence of mets (during CECT and Laparoscopy) were subjected to peritoneal wash cytology and their results were noted and analysed. RESULTS: Out of 22 patients studied, 4 were women (18%) and remaining18 were men (82%). Highest number of patients, 11 cases (50%) found to be in the age group of 40 to 60 years, 5 cases (22%) found to be in the age group of 60 years. Out of 11 patients with Metastatic CA, 9 patients were greater 50 years. Out of 10 patients with Locally Advanced CA, 7 patients were less than 50 years. Most common presenting complaints are Abdomen Pain (63%), Vomiting (63%) and LOA & LOW (77%). Out of 22 patients studied, 9 cases are smoker and alcoholic and remaining 13 cases were nonsmoker and non alcoholic. During general examination of patients included in my study, 10 cases were found to be anaemic. Out of 10 patients who are Anaemic, 7 patients were Metastatic and 3 patients were Locally Advanced. Out of 22 patients, 9 cases were presented with Gastric outlet obstruction, 7 cases had Abdominal pain, 5 case shade pigastric mass for evaluation and only1casewith UGI Bleed. The most common blood group in my study were O +ve and A+ve (7 cases each). During Upper GI Scopy, the most common site of growth were located in Antro pylorus of stomach (16 cases) percentage being 72%. In CECT (Abdomen and pelvis) of study patients, 8 patients were metastatic. The remaining14 patients subjected to D-lap / Laparotomy, 2 cases were found to be metastatic (peritonealmets) and 12 cases were subjected to peritoneal wash cytology out of which1case (8.33%) was found to be positive for peritoneal cytology. CONCLUSION: Peritoneal Wash cytology during Laparoscopy/Laparotomy though many studies have shown to Upstage the disease process from locally Advanced to Metastatic. Moreover, Positive cytologyrate 4. 4–11% reported in literature which reflects the heterogeneity of patient cohorts with variable disease severity, Experience of Pathology, Duration of sample retrieval to Sample Analysis & Differences in diagnostic criteria. In my study, there were only 1 positive cytology patients out of 12 patients (D-Lapnegative) examined. Positive cytologyrate being 8.33% Hence, institutional based study should be done to establish the significance of Peritoneal Wash cytology in CA Stomach