Percutaneous abdominal lavage cytology screening reduces non-therapeutic laparotomy in patients with pancreatic cancer considered for curative-intent resection: A single-institutional retrospective study.

Abstract

Assessing peritoneal cytology status is essential for determining the optimal treatment strategy in patients with pancreatic cancer. This study aimed to evaluate the safety and technical feasibility of percutaneous abdominal lavage cytology screening and its clinical utility in identifying patients unlikely to benefit from resection, thereby reducing nontherapeutic laparotomy. We retrospectively analyzed 225 consecutive patients with pancreatic cancer referred for potential curative-intent resection who underwent percutaneous abdominal lavage cytology screening between May 2022 and February 2026. Percutaneous abdominal lavage cytology screening was performed under local anesthesia with ultrasound and fluoroscopic guidance using 100 mL of saline. Recovery of less than 10 mL of lavage fluid was defined as technical failure. Cytology was classified from class I to V, with classes IV and V considered positive for malignancy. A total of 315 procedures were performed, with a technical success rate of 99.7% and 1 procedure-related complication (0.3%). Percutaneous abdominal lavage cytology screening identified positive cytology in 16 patients (7.1%). Overall, 39 patients (17.3%) were deemed ineligible for surgery owing to newly identified unresectable disease during the preoperative period. Excluding 8 patients awaiting surgery, 178 underwent laparotomy, among whom 12 (6.7%) were found to have unresectable disease intraoperatively; R0/1 resection was achieved in 166 patients. Intraoperative cytology positivity was observed in 1 patient (0.6%). Percutaneous abdominal lavage cytology screening is a safe, technically feasible, and repeatable method for preoperative cytology assessment in patients with pancreatic cancer considered for curative-intent resection. Integration of percutaneous abdominal lavage cytology screening into preoperative evaluation may improve surgical selection and reduce the rate of nontherapeutic laparotomy.