Objectives We aimed to develop a model predicting complete cytoreduction in primary cytoreductive surgery (CRS) using clinicopathologic characteristics and 18 F-FDG PET/CT (PET)derived parameters in advanced OC. Methods We retrospectively identified patients with stage III-IV OC who underwent primary CRS between June 2013 and February 2020 at two tertiary centers for development of a prediction model and for its validation. We divided abdominal cavity into three sections in PET images. The number of lesions in each section was counted and visual grading was conducted. Then, standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were estimated. We constructed various prediction models for complete cytoreduction by combination of clinicopathologic characteristics and PET-derived parameters. The model showing highest area under the receiver operating characteristic curve (AUC) was selected and its performance was evaluated for validation. Results Prediction models were designed with the development cohort (n=159). In variable selection, MTV, TLG, and the number of lesions above the renal vein were selected among PET-derived parameters with other clinical variables including CA-125 by AUC. The highest predictive performance was achieved by combination of CA-125 (<750 or ≧750 IU/ml), the number of lesions above the renal vein (<2 or ≧2) and MTV above the renal vein with AUC of 0.768. The model predicted complete cytoreduction with AUC of 0.771 in validation (n=166). Conclusions We successfully developed and validated PETbased prediction model for complete cytoreduction. It may be helpful for gynecologic oncologists to choose primary CRS or NACT in patients with stage III-IV OC in real-world practice.
e18745 Background: We report our experience of implementation of ERAS protocol in patients undergoing CRS and HIPEC for peritoneal carcinomatosis. Methods: ERAS protocol for CRS± HIPEC was implemented in 90 patients from January 2021 to October 2022. We documented compliance rate and analysed the reason for non-compliance, effect of compliance on length of hospital stay, postoperative complications and readmission rate and compared the same with the 95 patients who had CRS HIPEC before adopting ERAS protocol from January 2019 to December 2020. Results: Of 185 patients in the study, 95 were in pre eras group and 90 in ERAS group. Demography, pre-operative and operative parameters were comparable between the groups. The average compliance rate achieved for entire cohort was 78.5%. Lowest compliance rates were seen for post-operative elements especially, early feeding and early mobilization. After implementation of ERAS, median length of hospital stay reduced from 12 to 9 days, length of ICU stay reduced from 4 to 2 days and postoperative complications sepsis reduced from 14.7% to 7%, respiratory complications 15.7% to 7%, surgical complications 10.5% to 2.9%, resurgery from 6.3% to 1.4% and in hospital mortality reduced from 5.3% to 1.4%. The ERAS group didn’t receive any long acting opioids, less usage of intraoperative crystalloids(7ml/kg/hr vs 13ml/kg/hr, p = 0.0001),early extubation and less readmission rates. Conclusions: The implementation of ERAS protocol is safe and feasible for CRS and HIPEC patients. Implementation of ERAS program has significantly reduced the length of hospital stay, length of ICU stay and postoperative morbidity.
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