Usefulness of CEA Level in Peritoneal Washing from Patients with Gastric Cancer on Operation

Yoshimasa Ishii, Masayasu Takahashi, Kouichi Nakayama, Minoru Hotta, Eko Matsushima and Motoki Sassa

Department of Surgery, Oota Nishinouchi Hospital

Objectives and Methods: The most frequent recurrence in patients with gastric cancer is peritoneal metastasis. Since July 1997, we studied CEA in peritoneal washing from 221 patients with primary gastric cancer, 105 stage Ia, 26 stage Ib, 37 stage II, 21 stage IIIa, 14 stage IIIb, and 18 stage IV, and in peritoneal effusion from 21 patients with peritoneal dissemination after gastrectomy for gastric cancer. Our objective was to evaluate the usefulness as a predictor in diagnosing latent peritoneal dissemination, and cytology was conducted on the same samples. Results: (1) In patients with peritoneal effusion (33 cases, 46 samples), the incidence of positive cytology from peritoneal effusion was 61.4% and the positive result for CEA (>100 ng/g protein) in these samples was 91.3% (p<0.001). (2) In 25 patients with peritoneal dissemination, but not ascites, the incidence of positive cytology from peritoneal washing was 35% and positive CEA 68% (p<0.05). (3) In 30 patients with H0 P0 and serosal invasion and lymph node metastasis, whose curability was A or B, the incidence of positive cytology from peritoneal washing was 25% and positive CEA 62% (p<0.01). (4) In 11 patients with H0 P0 se n0, no case had positive cytology and 1 case had positive CEA. (5) In 48 patients with H0 P0 m-ss and lymph node metastasis, the incidence of positive cytology was 2.8% (1) and positive CEA 18.8% (p<0.001). (6) In 125 patients with H0 P0 m-ss n0, the incidence of positive cytology from peritoneal washing was zero and positive CEA 1 (ss n0). In almost all cases, CEA could not be determined because it was lower than the detectable range. (7) No correlation was seen between CEA in peritoneal effusion or washing and in serum. (8) In 35 patients with stage II and 16 with stage IIIa (16 cases), for whom better prognosis, was expected, survival curves for those undergoing curative surgery showed no significant difference between patients with positive and negative CEA from peritoneal washing, but in the positive CEA group, all recurrent patient died for peritoneal dissemination. Conclusion: We found that CEA in peritoneal effusion and washing correlated strongly with peritoneal dissemination and may be useful as a predictor in diagnosing latent peritoneal dissemination.

Key words
gastric cancer, CEA, peritoneal washing, peritoneal dissemination

Reprint requests
Yoshimasa Ishii Department of Surgery, Oota Nishinouchi Hospital 2-5-20 Nishinouchi, Kooriyama-City, 963-8558 JAPAN

Accepted
December 12, 2001

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