Prediction of suboptimal cytoreductive surgery in patients with advanced ovarian cancer based on preoperative and intraoperative determination of the peritoneal carcinomatosis index

• Published in: World journal of surgical oncology Vol. 16; no. 1; p. 37
• Main Authors: Llueca, Antoni, Serra, Anna, Rivadulla, Isabel, Gomez, Luis, Escrig, Javier
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23.02.2018; BioMed Central; BMC
• Subjects: Adenocarcinoma, Mucinous - pathology; Adenocarcinoma, Mucinous - surgery; Adult; Advanced ovarian cancer; Aged; Aged, 80 and over; Care and treatment; Cystadenocarcinoma, Serous - pathology; Cystadenocarcinoma, Serous - surgery; Cytoreduction Surgical Procedures - adverse effects; Cytoreductive surgery; Diagnosis; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Female; Follow-Up Studies; Humans; Intraoperative Care; Laparoscopy; Laparotomy; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - etiology; Neoplasm Recurrence, Local - pathology; Neoplasm, Residual - diagnostic imaging; Neoplasm, Residual - etiology; Neoplasm, Residual - pathology; Ovarian cancer; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Peritoneal carcinomatosis index; Peritoneal Neoplasms - diagnostic imaging; Peritoneal Neoplasms - etiology; Peritoneal Neoplasms - pathology; Preoperative Care; Prognosis; Prospective Studies; Retrospective Studies; Tomography, X-Ray Computed - methods; Spain; Peritoneal carcinomatosis index; Advanced ovarian cancer; Cytoreductive surgery
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-018-1339-0

The peritoneal carcinomatosis index (PCI) can be used to quantify the tumor burden in patients with advanced ovarian cancer. The aim of the present study was to establish a predictive model for suboptimal cytoreductive surgery (SCS) (residual tumor of > 1 cm) using preoperative and intraoperative determination of the PCI. In total, 110 consecutive patients treated for advanced ovarian cancer during a 4-year period in our institution were assessed. Eighty of these patients were eligible for primary debulking surgery and thus included in the present study. All data were prospectively collected and retrospectively evaluated. We determined the PCI both preoperatively and intraoperatively and assessed postoperative complications. A PCI of > 20 was the best cut-off with which to predict a risk of SCS among all three diagnostic techniques assessed in this study (computed tomography, laparoscopy, and laparotomy). Intraoperative PCI determination was associated with the lowest risk of false negatives for SCS when detecting a PCI of < 20. The combination of preoperative computed tomography and laparoscopy, when both techniques predicted SCS, was associated with the lowest risk of false positives for SCS when detecting a PCI of > 20. The combination of computed tomography and laparoscopy to obtain the PCI can help to determine which patients with advanced ovarian cancer are suitable for primary debulking surgery and which should undergo neoadjuvant chemotherapy.