- Consider in patients with gastric cancer or GOJ cancer
- All fit patients being considered for resection
-
T1
- Without metastatic disease on CT
- Who would not otherwise need a gastrectomy for symptoms
- Do in any patient being considered for neoadjuvant therapy
- Esp. useful assessment if suggestion of locoregional spread, large tumour or at GOJ
- Detects peritoneal/metastatic disease in 20-30% of pts with disease beyond T1
- Pts best palliated by chemo, so will change management
- Higher in T4 disease and linitis plastica
- Peritoneal cytology
- At least 200ml of normal saline instilled
- Placed across different quadrants of abdo, i.e. left and right sub-phrenic space, Pouch of Douglas
- Fluid should be dispersed
- Aspirations from different parts of the body
- 50ml should be sent for analysis
- NB: Positive washings only does not mean patient is incurable
- +ve cells → ↓ prognosis (but not in Stage IA)
- Median survival 10-13 months (or 15 months with chemo)
- cf patients with overt mets (9 month overall survival)
- Indication for neoadjuvant treatment if no gross mets but washings positive
- Should repeat laparoscopy and washings at completion of treatment