EP1275 Concordance of peritoneal cancer index using a two-step surgical protocol to select patients for cytoreductive surgery in ovarian cancer

2019 ◽  
Author(s):  
M Del ◽  
M Angeles ◽  
F Migliorelli ◽  
C Martínez-Gómez ◽  
M Voglimacci ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Peritoneal Cancer ◽  
Surgical Protocol

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.

Pre-operative serum CA125, peritoneal cancer index and intra-operative mapping score as predictors of surgical results in primary epithelial ovarian cancer

2019 ◽  
Vol 30 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Mustafa Zelal Muallem ◽  
Jalid Sehouli ◽  
Rolf Richter ◽  
Aygun Babayeva ◽  
Khayal Gasimli ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Residual Tumor ◽  
Incomplete Resection ◽  
Characteristic Analysis ◽  
Peritoneal Cancer ◽  
Serum Ca125 ◽  
Primary Epithelial Ovarian Cancer

ObjectivePrediction of post-operative residual disease after ovarian cancer cytoreductive surgery remains a topic of interest to gynecologic oncologists. The aim of this study was to explore the correlation between serum CA125, peritoneal cancer index, and intra-operative mapping of ovarian cancer and their predictive value for post-operative outcome.MethodsA total of 70 patients with primary epithelial ovarian cancer, who underwent primary cytoreductive surgery at Charité, Berlin between January 2013 and February 2014 were included. In all patients, pre-operative CA125 values, intra-operative peritoneal cancer index, and intra-operative mapping of ovarian cancer were determined.ResultsUsing a receiver operating characteristic analysis, cut-off values for CA125, peritoneal cancer index, and intra-operative mapping of ovarian cancer score could be defined. Patients with pre-operative serum CA125 >600 U/mL had a three times higher risk for residual tumor after primary cytoreductive surgery (p=0.037). A peritoneal cancer index score >20 indicated a nine times increased risk for residual tumor (p=0.003). More than six affected abdominopelvic fields on the intra-operative mapping of ovarian cancer was associated with a 25 times higher risk of residual tumor after primary cytoreductive surgery (p≤0.05). The combination of all three values predicted residual tumor in up to 90% of patients.ConclusionWe found that pre-operative CA125 >600 U/mL, peritoneal cancer index >20, and intra-operative mapping of ovarian cancer score >6 could be used as predictors of complete tumor resection. The combination of all these three values predicted the incomplete resection of disease in up to 90% of patients even in experienced centers.

scholarly journals The Peritoneal Cancer Index is a Strong Predictor of Incomplete Cytoreductive Surgery in Ovarian Cancer

2020 ◽  
Vol 28 (1) ◽  
pp. 244-251 ◽  
Author(s):  
Björg Jónsdóttir ◽  
Marta Lomnytska ◽  
Inger Sundström Poromaa ◽  
Ilvars Silins ◽  
Karin Stålberg
Keyword(s):  
Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Surgical Complications ◽  
Peritoneal Cancer Index ◽  
Strong Predictor ◽  
Area Under The Curve ◽  
Tumor Burden ◽  
Peritoneal Cancer ◽  
Tumor Load ◽  
Incomplete Surgery

Abstract Background Extent of tumor load is an important factor in the selection of ovarian cancer patients for cytoreductive surgery (CRS). The Peritoneal Cancer Index (PCI) gives exact information on tumor load but still is not standard in ovarian cancer surgery. The aim of this study was to find a PCI cutoff for incomplete CRS. The secondary aims were to identify reasons for open-close surgery and to compare surgical complications in relation to tumor burden. Methods The study included 167 women with stage III or IV ovarian cancer scheduled for CRS. Possible predictors of incomplete surgery were evaluated with receiver operator curves, and a PCI cutoff was identified. Surgical complications were analyzed by one-way analysis of variance and Chi square tests. Results The median PCI score for all the patients was 22 (range 3–37) but 33 (range 25–37) for the patients with incomplete surgery (n = 19). The PCI predicted incomplete CRS, with an area under the curve of 0.94 (95% confidence interval [CI], 0.91–0.98). Complete CRS was obtained for 67.2% of the patients with a PCI higher than 24, who experienced an increased rate of complications (p = 0.008). Overall major complications were found in 16.9% of the cases. Only 28.6% of the patients with a PCI higher than 33 achieved complete CRS. The reason for open-close surgery (n = 14) was massive carcinomatosis on the small bowel in all cases. Conclusion The study found PCI to be an excellent predictor of incomplete CRS. Due to a lower surgical success rate, the authors suggest that neoadjuvant chemotherapy could be considered if the PCI is higher than 24. Preoperative radiologic assessment should focus on total tumor burden and not necessarily on specific regions.

scholarly journals Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis from Colorectal Cancer

2020 ◽  
Vol 33 (06) ◽  
pp. 372-376
Author(s):  
Hideaki Yano
Keyword(s):  
Colorectal Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Peritoneal Metastasis ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Systemic Disease ◽  
Good Reason ◽  
Standard Of Care ◽  
Peritoneal Cancer

AbstractPeritoneal metastasis from colorectal cancer (PM-CRC) is used to be considered a systemic and fatal condition; however, it has been growingly accepted that PM-CRC can still be local disease rather than systemic disease as analogous to liver or lung metastasis.Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is now considered an optimal treatment for PM-CRC with accumulating evidence. There is a good reason that CRS + HIPEC, widely accepted as a standard of care for pseudomyxoma peritonei (PMP), could be a viable option for PM-CRC given a similarity between PM-CRC and PMP.Recent years have also seen that modern systemic chemotherapy with or without molecular targeted agents can be effective for PM-CRC. It is possible that neoadjuvant or adjuvant chemotherapy combined with CRS + HIPEC could further improve outcomes.Patient selection, utilizing modern images and increasingly laparoscopy, is crucial. Particularly, diagnostic laparoscopy is likely to play a significant role in predicting the likelihood of achieving complete cytoreduction and assessing the peritoneal cancer index score.

scholarly journals Hemodynamic Monitoring During Heated Intraoperative Intraperitoneal Chemotherapy Using the FloTrac/Vigileo System

2015 ◽  
Vol 100 (6) ◽  
pp. 1033-1039 ◽  
Author(s):  
Christos Mavroudis ◽  
Leonidas Alevizos ◽  
Konstantinos M. Stamou ◽  
Theodosia Vogiatzaki ◽  
Savvas Eleftheriadis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Venous Pressure ◽  
Term Survival ◽  
Continuous Increase ◽  
Peritoneal Cancer ◽  
American Society ◽  
American Society Of Anesthesiologists

Cytoreductive surgery with HIPEC has provided a chance for long-term survival in selected patients. However, perioperative management remains a challenge for the anesthesiology team. The aim of this study was to evaluate the changes in hemodynamic parameters during hyperthermic intraperitoneal chemotherapy (HIPEC) using the FloTrac/Vigileo system. Forty-one consecutive patients undergoing cytoreductive surgery and HIPEC were enrolled. Heart rate (HR), esophageal temperature, and cardiac output (CO) steadily increased until the end of HIPEC. In the first half of HIPEC, systolic blood pressure (SBP) and central venous pressure (CVP) increased whereas systemic vascular resistance (SVR) decreased; SVR stabilized in the second half. Diastolic blood pressure (DBP), mean arterial pressure (MAP), and stroke volume (SV) showed no significant variation. Male gender was related to increased CVP, CO, and SV, and decreased SVR; age &gt;55 years was related to increased SBP, and peritoneal cancer index (PCI) was correlated with HR, DBP, and SV. PCI &gt;14 was associated with increased HR and decreased DBP and MAP. American Society of Anesthesiologists score &gt;1 was related to decreased CO and SV. Patients undergoing HIPEC develop a hyperdynamic circulatory state because of the increased temperature, characterized by a steady decrease in SVR and continuous increase in HR and CO. FloTrac/Vigileo system may provide an easy-to-handle, noninvasive monitoring tool.

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