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Revista chilena de cirugía

versión On-line ISSN 0718-4026

Resumen

BURDILES P, Patricio et al. Ultrastructural changes of visceral peritoneum in patients with gastric cancer. Rev Chil Cir [online]. 2007, vol.59, n.1, pp.22-30. ISSN 0718-4026.  http://dx.doi.org/10.4067/S0718-40262007000100006.

Background: More than half of patients with gastric cancer have peritoneal metastases. Cancer cells exfoliated from the tumor can implant and proliferate in areas of damaged peritoneum or in areas of mesothelial denudation. Aim: To study peritoneal ultrastructure in patients with early and advanced gastric cancer. Material and Methods: Four patients with gastric cancer invading up to the muscular layer, 10 patients with gastric cancer invading the serosa and four patients operated for gastroesophageal reflux, were studied. A peritoneal sample from the root of the mesentery and a sample from peritoneal lavage, were obtained and analyzed by scanning electron microscopy. Patients with previous abdominal surgery or a positive peritoneal cytology for malignant cells, were excluded. Results: Among controls, abundant superficial microvilli and a faint definition on intercellular junctions was observed. In cancer patients, a reduction in microvilli and loss of intercellular junctions (mosaic pattern) or a loss of polygonal structure with focal loss of mesothelial cells, exposing the lamina propia (denudation pattern), were observed. A normal, mosaic or denudation pattern was observed in 90.1%, 7.6% and 2.3% of controls respectively, in 98,0 and 2% of patients with cancer invading up to the muscular layer respectively and 41, 42 and 17% of patients with cancer invading the serosa respectively (p<0.001 compared with the former two groups). Conclusions: Among patients with gastric cancer that invades the serosal surface, the visceral peritoneum experiences a loss of normal architecture and focal cellular denudation. These changes are not associated with the presence of free cancer cells in the peritoneal cavity and may precede the appearance of peritoneal metastases

Palabras clave : Gastric cancer; peritoneum; peritoneal invasion; electron microscopy.

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