Accuracy and Reproducibility of the Peritoneal Cancer Index in Advanced Ovarian Cancer During Laparoscopy and Laparotomy

2013 ◽  
Vol 23 (9) ◽  
pp. 1699-1703 ◽  
Author(s):  
Sébastien Gouy ◽  
Jérémie Belghiti ◽  
Catherine Uzan ◽  
Geoffroy Canlorbe ◽  
Tristan Gauthier ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Intraclass Correlation ◽  
Advanced Ovarian Cancer ◽  
Correlation Coefficients ◽  
Peritoneal Cancer ◽  
Senior Surgeon ◽  
The Mean

BackgroundThe aim of this prospective study was to evaluate the accuracy of the peritoneal cancer index (PCI) between laparoscopy and laparotomy and to evaluate the reproducibility of this index between 2 surgeons (junior vs senior) in advanced-stage ovarian cancer (ASOC). In ASOC, the quality of cytoreductive surgery, which is the main prognostic factor, is correlated with the extent of the disease and thus with the PCI. The reliability of this scoring index between different surgeons during laparoscopy and laparotomy has not been investigated in this disease.MethodsBetween April 2010 and October 2011, for each of the 29 patients undergoing complete cytoreductive surgery, 1 senior surgeon and 1 junior surgeon quantified the PCI score at 3 time points on the same day: during laparoscopy and during laparotomy, at the beginning and at the end. A concordance analysis was conducted with Bland and Altman’s method and estimated by intraclass correlation coefficients.ResultsThere was high concordance of the PCI score between the junior and senior surgeons during the laparoscopic and laparotomic procedures: the mean differences were not significantly different from 0 (P< 0.05) and 95% limits of agreement were ±3.5 and ±3.0, respectively. Laparoscopy underestimated the PCI score by approximately 2 points compared to the beginning of the laparotomy: the mean biases were −2.0 (95% confidence interval, −2.8 to −1.2) for the senior surgeon and −2.2 (95% confidence interval, −3.1 to 1.3) for the junior surgeon.ConclusionsThe PCI is reproducible and reliable for evaluating peritoneal spread in ASOC.

The rate and role of diaphragmatic peritonectomy in optimal cytoreduction in patients with advanced stage ovarian cancer: a prospective study of 100 patients

2014 ◽  
Vol 21 (1) ◽  
pp. 1-7
Author(s):  
Tomas Lūža ◽  
Agnė Ožalinskaitė ◽  
Vilius Rudaitis
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Cytoreductive Surgery ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Optimal Cytoreduction ◽  
Entire Cohort ◽  
Kaplan Meier ◽  
Upper Abdominal ◽  
A Prospective Study

Background. Diaphragmatic peritoneal metastasis by advanced epi­thelial ovarian cancer is a very common holdback precluding optimal cytoreduction. The aim of this study was to determine the rate of dia­phragmatic peritonectomy during optimal cytoreductive surgery and its role in postoperative morbidity and survival in patients with advanced ovarian cancer. Materials and methods. 100 consecutive patients with advanced epithelial ovarian cancer underwent cytoreductive surgery and were followed up prospectively (January 2009 – March 2014). Characteristics of surgery, rate of diaphragmatic peritonectomy and post operative complications were assessed. The Kaplan-Meier method was used for survival analysis. Results. The median age of the entire cohort at the time of primary cytoreduction was 58.5 years (23–83). Optimal cytoreduction was achieved in 73 cases out of 100 patients. From 73 patients in 30 cases (41.1%) upper abdominal procedures, specifically diaphragmatic peritonectomy, was performed to achieve the main goal of cytoreduction  –  no visible or palbable disease at the end of cytoreduction. Non-optimal cytoreduction was achieved in 27 cases. According to the Clavien-Dindo complication grading system grade I and grade II complications occurred more often in patients that underwent diaphragmatic surgery. The median overall survival from the time of diagnosis to the last follow-up or death was 28 months (range 0–63 months). The factors associated with the longest survival after primary cytoreductive surgery were the disease free interval from the primary cytoreduction of more than 19 months (n = 51) versus less than 19 months (n = 49) (95% confidence interval, 51.7–59.5; P = 0.013) and no visible or palpable residual disease at the end of cytoreduction (n = 73) versus visible or palpable residual di­sease (n = 27) (95% confidence interval, 52.7–61.2; P = 0.03). Conclusions. Based on our prospective analysis of advanced ovarian cancer patients, diaphragmatic peritonectomy is feasible and safe, ensures better rates of optimal cytoreduction and should not be an obstacle towards better survival.

Prognostic value of peritoneal cancer index in primary advanced ovarian cancer

2018 ◽  
Vol 44 (1) ◽  
pp. 163-169 ◽  
Author(s):  
Antoni Llueca ◽  
Javier Escrig ◽  
A. Serra-Rubert ◽  
L. Gomez-Quiles ◽  
I. Rivadulla ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Prognostic Value ◽  
Peritoneal Cancer Index ◽  
Advanced Ovarian Cancer ◽  
Peritoneal Cancer

scholarly journals Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy Improves Survival with Acceptable Safety for Advanced Ovarian Cancer: A Clinical Study of 100 Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Jue Zhang ◽  
Xin-bao Li ◽  
Zhong-he Ji ◽  
Ru Ma ◽  
Wen-pei Bai ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Surgical Treatment ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Karnofsky Performance Status ◽  
Univariate Analysis ◽  
Advanced Ovarian Cancer ◽  
First Line

Background. The mainstay of treatment for advanced ovarian cancer is debulking surgery followed by chemotherapy that includes carboplatin and paclitaxel, but the prognosis is poor. This study is aimed at evaluating the efficacy and safety of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) as first-line surgical treatment in patients with advanced ovarian cancer (AOC). Methods. FIGO stage III/IV AOC patients underwent CRS+HIPEC as first-line surgical treatment at our center from December 2007 to January 2020. The primary endpoint was survival, and the secondary endpoint was safety. Results. Among 100 patients, the median Karnofsky performance status (KPS) score was 80 (50-100), median peritoneal cancer index (PCI) was 19 (1-39), median completeness of cytoreduction (CC) score was 1 (0-3), number of organ regions removed was 4 (3-9), number of peritoneal regions removed was 4 (1-9), and number of anastomoses was 1 (0-4). The median follow-up was 36.8 months; 75 (75.0%) patients were still alive, and 25 (25.0%) had died. The median overall survival (mOS) was 87.6 (95% CI: 72.1-103.0) months, and the 1-, 2-, 3-, 4-, and 5-year survival rates were 94.1%, 77.2%, 68.2%, 64.2%, and 64.2%, respectively. Univariate analysis showed that better mOS correlated with an age ≤, KPS ≥ 80 , ascites ≤ 1000  ml, PCI < 19 , and CC score 0-1. Multivariate Cox analysis showed that CC was an independent factor for OS; patients who underwent CRS with a CC score 0-1 had a mPFS of 67.8 (95% CI: 48.3-87.4) months. The perioperative serious adverse event and morbidity rates were 4.0% and 2.0%, respectively. Conclusions. CRS+HIPEC improves survival for AOC patients with acceptable safety at experienced high-volume centers. Stringent patient selection and complete CRS are key factors for better survival.

scholarly journals Role of Reactive Thrombocytosis After Primary Cytoreductive Surgery in Advanced Ovarian Cancer

2021 ◽  
Author(s):  
Seung Hun Baek ◽  
Myeong-Seon Kim ◽  
Joseph J. Noh ◽  
Jung In Shim ◽  
Jun Hyeok Kang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Adjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Advanced Ovarian Cancer ◽  
Reactive Thrombocytosis ◽  
Peritoneal Cancer ◽  
Time Points ◽  
Platelet Counts ◽  
Advanced Epithelial Ovarian Cancer

Abstract Background: We investigated the incidence of reactive thrombocytosis after maximal cytoreductive surgery in advanced epithelial ovarian cancer and its role on survival. Methods: We retrospectively reviewed electronic medical records of patients who underwent primary cytoreductive surgery for advanced epithelial ovarian/fallopian cancer or peritoneal cancer from January 1, 2012, and December 31, 2017. In addition to known clinical prognostic factors, we analyzed the correlation serum platelet counts and prognosis at various time points including before surgery, during peri-operative period, and on each cycle of adjuvant chemotherapy.Results: 474 patients were eligible for the analysis. Median age was 54 years (18-88). 401 patients (84.6%) were FIGO stage III and 405 patients (85.4%) were serous adenocarcinoma. 79 patients (22.6%) had splenectomy and optimal cytoreduction (residual < 1 cm) was achieved at 326 patients (68.8%). A week after surgery, thrombocytosis was observed in 229 patients (48.3%) patients in the entire cohort. Especially, higher platelet counts were observed in patients with splenectomy compared with patients without splenectomy at various time points after surgery. Subgroup of patients who had persistent thrombocytosis during adjuvant chemotherapy showed poor survivals. In particular, thrombocytosis on 5th cycle of adjuvant chemotherapy showed most significant impact on overall survival (HR; 1.871, 95%CI; 1.034-3.386, p = 0.038) among various time points in multivariate analysis. In a logistic regression model, splenectomy (p < 0.001) significantly attributed to thrombocytosis on 5th cycle. Conclusion: Reactive thrombocytosis after primary cytoreductive surgery is associated with poor survival in advanced epithelial ovarian cancer, particularly when thrombocytosis was observed during adjuvant chemotherapy.

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