{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:14:23Z","timestamp":1783084463294,"version":"3.54.6"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"crossref","award":["JP25ama121054"],"award-info":[{"award-number":["JP25ama121054"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100008702","name":"Kagoshima University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008702","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Today"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Pleural lavage cytology (PLC) is a recognized prognostic marker in non-small cell lung cancer (NSCLC); however, the impact of serial intraoperative changes remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 439 patients who underwent curative NSCLC resection. PLC was performed at three intraoperative points: after thoracotomy (pre-PLC), after lung resection, and after lavage at chest closure (post-PLC). Associations between recurrence-free survival (RFS) and pleural dissemination were evaluated by a Kaplan\u2013Meier analysis and Fine and Gray competing risks regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty-one patients had at least one positive PLC result. RFS was the lowest in pre-PLC(\u2009+)\/post-PLC(\u2009+) (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910), intermediate in pre-PLC(\u2013)\/post-PLC(\u2009+) (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911), and best in post-PLC(\u2009\u2212) (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920). Importantly, post-PLC(\u2009\u2212) patients included 13 patients with pre-PLC positivity, yet their RFS matched that of consistently negative cases (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009398). The cumulative incidence of pleural dissemination exhibited a similar pattern. In a multivariate analysis, post-PLC positivity, but not pre-PLC positivity, independently predicted poor RFS (hazard ratio, 3.06;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Post-PLC, but not pre-PLC, provides decisive prognostic information for recurrence and pleural dissemination, likely reflecting residual lavage-resistant tumor clusters. Importantly, combining pre- and post-PLC results refines risk stratification and identifies the poorest-outcome subgroup that may benefit from adjuvant therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00595-025-03159-y","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T05:49:19Z","timestamp":1760680159000},"page":"455-461","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Serial changes in pleural lavage cytology during lung cancer surgery predict recurrence and pleural dissemination"],"prefix":"10.1007","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6895-8229","authenticated-orcid":false,"given":"Go","family":"Kamimura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaya","family":"Aoki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satomi","family":"Imamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoichiro","family":"Morizono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuto","family":"Nonaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Tokunaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya","family":"Harada-Takeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koki","family":"Maeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiyuki","family":"Nagata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Ueda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"3159_CR1","first-page":"229","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74:229\u201363.","journal-title":"CA Cancer J Clin"},{"key":"3159_CR2","first-page":"242","volume":"3","author":"H Uramoto","year":"2014","unstructured":"Uramoto H, Tanaka F. Recurrence after surgery in patients with NSCLC. Transl Lung Cancer Res. 2014;3:242\u20139.","journal-title":"Transl Lung Cancer Res"},{"key":"3159_CR3","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1002\/1097-0142(195811\/12)11:6<1222::AID-CNCR2820110618>3.0.CO;2-U","volume":"11","author":"HJ Spjut","year":"1958","unstructured":"Spjut HJ, Hendrix VJ, Ramirez GA, Roper CL. Carcinoma cells in pleural cavity washings. Cancer. 1958;11:1222\u20135.","journal-title":"Cancer"},{"key":"3159_CR4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0157518","volume":"11","author":"CM Wang","year":"2016","unstructured":"Wang CM, Ling ZG, Wu YB, Cai SQ, Tang ZM, Wu C, et al. Prognostic value of pleural lavage cytology in patients with lung cancer resection: an updated meta-analysis. PLoS ONE. 2016;11:e0157518.","journal-title":"PLoS ONE"},{"key":"3159_CR5","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.lungcan.2007.09.024","volume":"60","author":"YN Li","year":"2008","unstructured":"Li YN, Shi HZ, Liang QL, Yang HB, Huang GM. Prognostic significance of pleural lavage cytology in patients with lung cancer: a meta-analysis. Lung Cancer. 2008;60:183\u201392.","journal-title":"Lung Cancer"},{"key":"3159_CR6","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1016\/S0003-4975(99)00220-9","volume":"67","author":"CM Dresler","year":"1999","unstructured":"Dresler CM, Fratelli C, Babb J. Prognostic value of positive pleural lavage in patients with lung cancer resection. Ann Thorac Surg. 1999;67:1435\u20139.","journal-title":"Ann Thorac Surg"},{"key":"3159_CR7","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1016\/j.athoracsur.2005.06.073","volume":"81","author":"S Enatsu","year":"2006","unstructured":"Enatsu S, Yoshida J, Yokose T, Nishimura M, Nishiwaki Y, Shirakusa T, et al. Pleural lavage cytology before and after lung resection in non-small cell lung cancer patients. Ann Thorac Surg. 2006;81:298\u2013304.","journal-title":"Ann Thorac Surg"},{"key":"3159_CR8","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1097\/JTO.0b013e31812f3c1a","volume":"2","author":"P Goldstraw","year":"2007","unstructured":"Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC lung cancer staging project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol. 2007;2:706\u201314.","journal-title":"J Thorac Oncol"},{"key":"3159_CR9","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.asjsur.2018.03.001","volume":"42","author":"T Nakmura","year":"2019","unstructured":"Nakmura T, Otsuki Y, Nakamura H, Funai K. Pleural lavage cytology after lung resection in patients with non-small cell lung cancer and the feasibility of 20ml saline solution. Asian J Surg. 2019;42:283\u20139.","journal-title":"Asian J Surg"},{"key":"3159_CR10","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1097\/00000658-199904000-00019","volume":"229","author":"M Okada","year":"1999","unstructured":"Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Maniwa Y. Role of pleural lavage cytology before resection for primary lung carcinoma. Ann Surg. 1999;229:579\u201384.","journal-title":"Ann Surg"},{"key":"3159_CR11","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1007\/s00595-022-02617-1","volume":"54","author":"M Hao","year":"2024","unstructured":"Hao M, Fang Z, Ding J, Li C, Wei Y, Zhang W. Effects of preoperative needle biopsy for lung cancer on survival and recurrence: a systematic review and meta-analysis. Surg Today. 2024;54:95\u2013105.","journal-title":"Surg Today"},{"key":"3159_CR12","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1510\/icvts.2009.206045","volume":"9","author":"Y Taniguchi","year":"2009","unstructured":"Taniguchi Y, Nakamura H, Miwa K, Adachi Y, Fujioka S, Haruki T, et al. Prognostic significance of pleural lavage cytology after thoracotomy and before closure of the chest in lung cancer. Interact Cardiovasc Thorac Surg. 2009;9:102\u20136.","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"3159_CR13","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1016\/j.jtcvs.2009.07.049","volume":"139","author":"K Aokage","year":"2010","unstructured":"Aokage K, Yoshida J, Ishii G, Enatsu S, Hishida T, Nishimura M, et al. The impact on survival of positive intraoperative pleural lavage cytology in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg. 2010;139:1246\u201352.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"3159_CR14","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1016\/j.jtcvs.2008.09.027","volume":"137","author":"Y Shintani","year":"2009","unstructured":"Shintani Y, Ohta M, Iwasaki T, Ikeda N, Kanou T, Tomita E, et al. Intraoperative pleural lavage cytology after lung resection as an independent prognostic factor for staging lung cancer. J Thorac Cardiovasc Surg. 2009;137:835\u20139.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"3159_CR15","doi-asserted-by":"publisher","DOI":"10.1510\/mmcts.2020.015","author":"K Ueda","year":"2019","unstructured":"Ueda K, Aoki M, Maeda K, Umehara T, Kariatsumari K, Takeda AH, et al. Thoracoscopic en bloc resection of left upper lobe lung cancer. Multimed Man Cardiothorac Surg. 2019. https:\/\/doi.org\/10.1510\/mmcts.2020.015.","journal-title":"Multimed Man Cardiothorac Surg"},{"issue":"1","key":"3159_CR16","doi-asserted-by":"publisher","first-page":"19","DOI":"10.21037\/jtd.2018.10.03","volume":"11","author":"Y Tachimori","year":"2019","unstructured":"Tachimori Y. En bloc has the priority of lymph node dissection regardless non-grasping or grasping approaches. J Thorac Dis. 2019;11(1):19\u201320.","journal-title":"J Thorac Dis"},{"key":"3159_CR17","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1158\/1078-0432.CCR-10-0445","volume":"17","author":"V Hofman","year":"2011","unstructured":"Hofman V, Bonnetaud C, Ilie Ml, Vielh P, Vignaud JM, Fl\u00e9jou JF, et al. Preoperative circulating tumor cell detection using the isolation by size of epithelial tumor cell method for patients with lung cancer is a new prognostic biomarker. Clin Cancer Res. 2011;17:827\u201335.","journal-title":"Clin Cancer Res"},{"key":"3159_CR18","doi-asserted-by":"publisher","first-page":"1556","DOI":"10.1200\/JCO.2010.28.7045","volume":"29","author":"MG Krebs","year":"2011","unstructured":"Krebs MG, Sloane R, Priest L, Lancashire L, Hou JM, Greystoke A, et al. Evaluation and prognostic significance of circulating tumor cells in patients with non-small cell lung cancer. J Clin Oncol. 2011;29:1556\u201363.","journal-title":"J Clin Oncol"},{"key":"3159_CR19","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1016\/j.cell.2014.07.013","volume":"158","author":"N Aceto","year":"2014","unstructured":"Aceto N, Bardia A, Miyamoto DT, Donaldson MC, Wittner BS, Spencer JA, et al. Circulating tumor cell clusters are oligoclonal precursors of breast cancer metastasis. Cell. 2014;158:1110\u201322.","journal-title":"Cell"},{"key":"3159_CR20","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1126\/science.aaf6546","volume":"352","author":"KJ Cheung","year":"2016","unstructured":"Cheung KJ, Ewald AJ. A collective route to metastasis: seeding by tumor cell clusters. Science. 2016;352:167\u20139.","journal-title":"Science"},{"key":"3159_CR21","doi-asserted-by":"publisher","first-page":"2114","DOI":"10.1007\/s10350-004-0788-4","volume":"47","author":"LH Emmanuel","year":"2004","unstructured":"Emmanuel LH, Neil JK. Distilled water peritoneal lavage after colorectal cancer surgery. Dis Colon Rectum. 2004;47:2114\u20139.","journal-title":"Dis Colon Rectum"},{"key":"3159_CR22","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1002\/jso.20596","volume":"94","author":"CH Lin","year":"2006","unstructured":"Lin CH, Hsieh HF, Yu JC, Chen TW, Yu CY, Hsieh CB. Peritoneal lavage with distilled water during liver resection in patients with spontaneously ruptured hepatocellular carcinomas. J Surg Oncol. 2006;94:255\u20136.","journal-title":"J Surg Oncol"},{"key":"3159_CR23","doi-asserted-by":"publisher","first-page":"2114","DOI":"10.1007\/s10350-004-0788-4","volume":"47","author":"EL Huguet","year":"2004","unstructured":"Huguet EL, Keeling NJ. Distilled water peritoneal lavage after colorectal cancer surgery. Dis Colon Rectum. 2004;47:2114\u20139.","journal-title":"Dis Colon Rectum"},{"key":"3159_CR24","doi-asserted-by":"publisher","first-page":"2779","DOI":"10.1002\/1097-0142(19850615)55:12<2779::AID-CNCR2820551210>3.0.CO;2-H","volume":"55","author":"DB Mercill","year":"1985","unstructured":"Mercill DB, Jones NR, Harbell JW. Human tumor cell destruction by distilled water. An in vitro evaluation. Cancer. 1985;55:2779\u201382.","journal-title":"Cancer"},{"key":"3159_CR25","doi-asserted-by":"publisher","first-page":"11560","DOI":"10.3748\/wjg.v20.i33.11560","volume":"20","author":"A Shiozaki","year":"2014","unstructured":"Shiozaki A, Ichikawa D, Otsuji E, Marunaka Y. Cellular physiological approach for treatment of gastric cancer. World J Gastroenterol. 2014;20:11560\u20136.","journal-title":"World J Gastroenterol"}],"container-title":["Surgery Today"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00595-025-03159-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00595-025-03159-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00595-025-03159-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T07:49:05Z","timestamp":1774338545000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00595-025-03159-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["3159"],"URL":"https:\/\/doi.org\/10.1007\/s00595-025-03159-y","relation":{},"ISSN":["0941-1291","1436-2813"],"issn-type":[{"value":"0941-1291","type":"print"},{"value":"1436-2813","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]},"assertion":[{"value":"25 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflicts of interest in association with the present study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"At our institution, intraoperative pleural irrigation with sterile distilled water was introduced prior to the establishment of a hospital-wide notification system for off-label use; accordingly, during the study period it was performed at the discretion of the Department of General Thoracic Surgery under institutional oversight. This clinical study, which included the use of distilled water lavage, was approved by the Kagoshima University Hospital Ethics Committee (approval number: 230040). The participants and their relatives could opt out by viewing the research content hosted online.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Consent has been obtained from all concerned parties.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}