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Invited Commentary

Jon A. van Heerden, MB, FRCSC, FRCS (Edin)
Arch Surg. 1994;129(6):642. doi:10.1001/archsurg.1994.01420300086014.
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The name of the senior author of this report has been synonymous with excellence in the field of pancreatic surgery for many decades. The authors tell the reader that positive peritoneal cytologic findings suggest peritoneal carcinomatosis and that ascites in patients with pancreatic ductal adenocarcinoma does not necessarily mean diffuse, nonresectable, malignant disease. The former is certainly a well-established fact; the latter, less so. It is a sobering reminder to us not to parenthetically categorize the patient with pancreatic cancer and concomitant ascites as being beyond the scope of surgical salvage and for us to elicit other possible causes of ascites.

The data presented are, however, at variance with other reports from this country1,2 that have suggested that approximately 20% of patients with pancreatic ductal adenocarcinoma may have positive peritoneal cytologic findings in the absence of disseminated disease. These reports disturbingly have suggested that peritoneal seeding (positive cytologic findings)


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