Original Articles
Prognostic value of positive pleural lavage in patients with lung cancer resection

https://doi.org/10.1016/S0003-4975(99)00220-9Get rights and content

Abstract

Background. Despite an early stage, lung cancer patients often have a poor survival, suggesting inaccurate staging. A pleural lavage demonstrating malignant cells at the time of operation may predict a poorer survival, particularly in patients with otherwise early disease.

Methods. Patients, with no preoperative evidence of pleural effusions and undergoing a surgical resection with curative intent, had a preresectional and postresectional lavage to be evaluated by cytology.

Results. Fourteen percent of patients with stage I disease had malignant cells in their preresectional lavage and had a significantly shorter survival than stage I patients with a negative lavage. Positivity of preresectional lavage was not correlated with nodal status, pleural or lymphatic involvement, or histologic findings.

Conclusions. Preoperative pleural lavage should become a standard technique intraoperatively to better characterize and stage patients undergoing lung cancer resections. Patients with malignant cells in their preoperative lavage should be upstaged.

Section snippets

Material and methods

Between March 1995 and December 1997, 137 patients underwent pleural lavage during thoracotomy for potentially curative resection of lung cancer at Fox Chase Cancer Center. Patients with evidence of pleural fluid on posteroanterior or lateral chest roentgenogram were excluded from this study. Immediately after opening the pleura, 250 mL of warm Ringer’s lactate solution was instilled into the pleural space. The patient was gently rocked to assure thorough distribution. The fluid was then

Results

Table 1describes patient sex, age, procedure performed, histology, and stage.

A total of 107 (82%) of the 130 patients had negative preoperative and postoperative lavage cytology results. Of the 17 patients with positive preoperative cytology findings, 8 (47%) also had a positive postoperative lavage result. Among the 14 patients with positive cytology findings after resection, 8 (57%) had a positive preoperative lavage sample.

Comment

Cancer cells identified in a preoperative lavage in patients without a pleural effusion are evidence of micrometastatic disease. The outcome of these patients after standard surgical resection has not been established. Thus, it is unclear exactly where they fit into the staging system.

The first report on pleural cavity cytology was in 1958 by Spjut and associates [8]. They demonstrated a 46% positive pleural cytology findings (obtained after resection), but they did not analyze the patients for

Acknowledgements

Grateful acknowledgment is given to Melyvn Goldberg, MD, for performing pleural lavage on the patients he resected for lung cancer.

References (9)

There are more references available in the full text version of this article.

Cited by (45)

  • The Impact of Pleural Lavage Cytology Both before and after Lung Resection on Recurrence of Non-Small Cell Lung Cancer

    2016, Annals of Thoracic Surgery
    Citation Excerpt :

    Kotoulas and associates [6] reported that post-PLC positive status was an important prognostic factor. Dresler and associates [7] concluded that positive post-PLC status was significantly associated with worse survival. Enatsu and associates [8] reported that post-PLC status had a greater and independent impact on survival than pre-PLC status [8].

  • Pleural lavage cytology: Where do we standα

    2014, Lung Cancer
    Citation Excerpt :

    In that same study by Nakagawa et al., the pre-resectional PLC status was demonstrated to be an independent prognostic factor (P = 0.016), along with pleural invasion. The impact of a positive pre-resectional PLC on prognosis is much more apparent in early rather than advanced stages of lung cancer, presumably because the prognosis of advanced stages being so poor, a negative impact of a positive PLC is difficult to detect [13,21]. In other words, the more advanced the tumor, the higher the incidence of positive PLC, and the less the new prognostic information acquired [9].

View all citing articles on Scopus
View full text