Optimal cytoreduction: is a CT's picture worth a surgeon's word?

• Published in: Surgical oncology Vol. 49; p. 101948
• Main Authors: Trelis Blanes, Alexandra, Lago Leal, Víctor, Padilla Iserte, Pablo, Pérez Martínez, Rosario, Belloch Ripollés, Vicente, Matute, Luis, Gurrea, Marta, Cardenas Rebollo, Jose Miguel, Domingo del Pozo, Santiago
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.08.2023
• Subjects: Advanced ovarian cancer; CT scan; Optimal cytoreduction; Prognosis; Residual disease; Residual disease; Prognosis; Advanced ovarian cancer; Optimal cytoreduction; CT scan
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2023.101948

The presence of residual disease after cytoreductive surgery is subjectively determined by the surgeon at the end of the operation. Nevertheless, in up to 21–49% of CT scans, residual disease can be found. The aim of this study was to establish the relationship between post-surgical CT findings after optimal cytoreduction in patients with advanced ovarian cancer and oncological outcome. Patients with advanced ovarian cancer (FIGO II and IV), diagnosed between 2007 and 2019 in Hospital La Fe Valencia, in whom cytoreductive surgery was performed, achieving R0 or R1, were assessed for eligibility (n = 440). A total of 323 patients were excluded because a post-operative CT scan was not performed between the third and eighth post-surgery week and prior to the start of chemotherapy. 117 patients were finally included. The CT findings were classified into three categories: no evidence, suspicious or conclusive of residual tumour/progressive disease. 29.9% of CT scans were “conclusive of residual tumour/progressive disease”. No differences were found when the DFS (p = 0.158) and OS (p = 0.215) of the three groups were compared (p = 0.158). After cytoreduction in ovarian cancer with no macroscopic disease or residual tumour < 1 cm result, up to 29.9% of post-operative CT scans before chemotherapy found measurable residual or progressive disease. Notwithstanding, a worse DFS or OS was not associated with this group of patients. •The line of research is focused on whether with a detailed/structured reading of the CT scan, the findings can influence the prognosis.•In this study the optimal oncological outcome after surgery is compared with the conclusion of the post-surgical CT report, the report and the images are not intentionally reviewed. The fact that the presence of residual tumour on the CT scan does not influence prognosis is probably due to the way the report is interpreted (unstructured). As it is not interpreted in a systematic way, adequately assessing each quadrant and each anatomical region, the conclusion of the initial report may not be accurate.•We are working on other studies in order to prove this hypothesis.