Clinical significance of minimal ascites of indeterminate nature in gastric adenocarcinoma without peritoneal carcinomatosis: long-term follow-up study

Abstract

BACKGROUNDS/AIMS: CT-defined minimal ascites (CTMA) poses a dilemma in the preoperative staging of gastric cancer in order to select the therapeutic modality or predict outcome. The objective of this study was to investigate the outcomes of patients with gastric cancer accompanied by CTMA of an indeterminate nature on preoperative evaluation.

METHODOLOGY: The medical records and dynamic CT scans of patients with gastric cancer and CTMA (<50 mL), who had been examined 10 years earlier, were reviewed retrospectively. The long-term outcomes of these patients were compared with those of patients with gastric cancer of the same stage but without ascites.

RESULTS: Surgically confirmed peritoneal carcinomatosis occurred in 28.1% of 32 patients with CTMA. Multivariate regression analysis showed that peritoneal enhancement (RR: 76.41; CI: 9.06-644.58) and distant lymph-node enlargement (RR: 16.63; CI: 3.36-82.53) independently affected overall survival. Patients lacking these signs experienced no recurrence and survived for a 10-year period. In addition, CTMA did not affect the survivals in gastric cancer without confirmed peritoneal metastasis.

CONCLUSION: CTMA in gastric cancer does not influence the survival outcomes of gastric cancer without peritoneal carcinomatosis. Preoperative radiologic factors such as peritoneal enhancement and distant lymph node enlargement are important in predicting of CTMA-associated outcome