Journal of Surgical Oncology 2001;78:175±182 Is Borrmann Type IV Gastric Carcinoma a Surgical Disease? An Old Problem Revisited With Reference to the Result of Peritoneal Washing Cytology YASUHIRO KODERA, MD,* YOSHITAKA YAMAMURA, MD, SEIJI ITO, MD, YUKIHIDE KANEMITSU, MD, YASUHIRO SHIMIZU, MD, TAKASHI HIRAI, MD, KENZO YASUI, MD, AND TOMOYUKI KATO, MD Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Aichi, Japan Background and Objectives: Borrmann type IV gastric carcinoma (B-4) remains a disease with poor prognosis despite an aggressive surgical approach. Cytology examination of the peritoneal washes is an established prognostic factor for gastric carcinoma in general, and may be useful for identifying adequate treatment strategy for B-4. Methods: Pathologic data from 70 patients with B-4 who underwent laparotomy and peritoneal washing cytology during the recent 6 years were retrieved from a prospective computer database and reviewed. Prog- nostic signi®cance of the cytology examination along with other known clinicopathologic variables was evaluated by univariate and multivariate analyses. Results: Long-term survivors were observed only among the patients who were treated with curative R0 resection. Prognosis of the patients with positive cytology and no other residual disease (R1) was extremely poor and was equivalent to that of the patients undergoing noncurative R2 resection. No difference in survival, either, was observed between the patients treated by R2 resection and those who did not undergo resection. Multivariate analysis identi®ed cytology examination as an independent prognostic factor. Conclusions: Peritoneal washing cytology plays an important role in staging B4. Positive cytology ®ndings as well as other evidence of dis- seminated disease may indicate that gastrectomy should be avoided. J. Surg. Oncol. 2001;78:175±182. ß 2001 Wiley-Liss, Inc. KEY WORDS: peritoneal dissemination; gastrectomy; linitis plastica INTRODUCTION Borrmann type IV gastric carcinoma (B-4) is found in 12±14 % of all cases of advanced gastric carcinoma in leading institutions in Japan as well as in the West [1]. It is diffusely in®ltrative by nature and has a propensity toward involvement of the entire stomach, invasion of the gastric serosa, peritoneal seeding, and gross lymph node metastases [2]. In Japan, radical surgery with systemic extended lymphadenectomy has been considered effec- tive in the management of gastric carcinoma in general [3,4]. Authors along with others have shown some encouraging data indicating that the advantageous effect of the extended surgery applies also to B-4 [5±7], provided curative (R0) resection was performed. How- ever, prognosis of the patients with B-4, whose common pattern of failure is peritoneal dissemination, remains outstandingly poor in comparison with other types [8]. In Japan, noncurative resection remains a common practice for gastric carcinoma, with a hope that mass *Correspondence to: Yasuhiro Kodera, MD, Department of Gastroentero- logical Surgery, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi 464-8681, Japan. Fax: 81-52-763-5233. E-mail: ykodera@mvi.biglobe.ne.jp Accepted 9 August 2001 ß 2001 Wiley-Liss, Inc.