Significado Predictivo de Ascitis en TAC Preoperatorio en Cáncer Gástrico

Les presento el abstract de un trabajo retrospectivo realizado por investigadores japoneses investigando el valor predictivo de la presencia de ascitis en pacientes con cáncer gástrico respecto de la presencia de metastásis peritoneales. Los resultados de este trabajo muestran una correlación significativa con siembra peritoneal tanto en análisis univariado como multivariado.
Los autores recomiendan que en casos de pacientes con cáncer gástrico en quienes la tomografía axial computada muestre ascitis se proponga hacer una laparoscopia diagnóstica.

Clinical and diagnostic significance of preoperative computed tomography findings of ascites in patients with advanced gastric cancer
Kazuhito Yajima M.D.a, Tatsuo Kanda M.D., Ph.D.a, , , Manabu Ohashi M.D.a, Toshifumi Wakai M.D.a, Satoru Nakagawa M.D.a, Ryuta Sasamoto M.D.b and Katsuyoshi Hatakeyama M.D., Ph.D., F.A.C.S.b
aDivision of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, JapanbDivision of Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan Received 6 April 2005; revised 21 January 2006.

Background
The relationship between ascites, as detected by preoperative computed tomography (CT), and peritoneal metastasis of gastric cancer requires clarification because of its likely significance for clinical outcome.
Methods
A retrospective analysis of 293 patients with advanced gastric cancer investigated the association between preoperative CT findings of ascites and surgical findings of peritoneal washing cytology and peritoneal metastasis.
Results
Forty-five of 293 patients (15%) presented with ascites on preoperative CT. Positive ascites on CT predicted the presence of free tumor cells with 40% sensitivity and 97% specificity, and peritoneal metastasis with 51% sensitivity and 97% specificity. Ascites on CT was an independent prognostic factor by univariate (P < .001) and multivariate (relative risk, 2.03; 95% confidence interval, 1.39–2.96; P < .001) analyses. The median survival time was 6.0 months in patients with positive ascites on CT.
Conclusions
The presence of ascites on CT suggests the presence of peritoneal metastasis and indicates a poor prognosis. The presence of peritoneal metastasis should be confirmed by diagnostic laparoscopy in gastric cancer patients with ascites.