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

Ángeles, Martina Aida; Del, Mathilde; Martínez-Gómez, Carlos; Daix, Manon; Bétrian, Sarah; Gabiache, Erwan; Balagué, Gisèle; Leclerc, S; Mery-Lamarche, Eliane; Gladieff, Laurence; Ferron, Gwénaël; Martinez, Alejandra

doi:10.1007/s00404-020-05874-y

Cited by 10 publications

(7 citation statements)

References 34 publications

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“…The duration of prehabilitation in non-gynecological major abdominal surgeries ranges from 2 to 6 weeks [12]. In patients with AOC, it is important to complete the prehabilitation program in the shortest period of time possible to avoid tumor progression and detrimental effects on oncologic outcomes [13][14].…”

Section: Results In the Context Of Published Literaturementioning

confidence: 99%

“…Recent trials have shown that multimodal prehabilitation programs including extensive preoperative evaluation and nutritional and psychological strategies in addition to physical intervention have a positive impact on postoperative functional outcomes in other, non-gynecological major abdominal surgeries [10][11][12][13]. To our knowledge, strong evidence for the bene cial effects of prehabilitation in gynecological interventions is lacking [14]; the only published information available about prehabilitation programs in patients with gynecologic cancer comes from a single case report [15]. Thus, we aimed to evaluate the feasibility and effectiveness of a multimodal prehabilitation program in patients undergoing surgery for AOC.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of a Multimodal Prehabilitation Program in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer: a Pilot Study

Díaz-Feijoó¹,

Agustí²,

Sebio³

et al. 2021

Preprint

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Purpose The feasibility and effects of multimodal prehabilitation in patients with advanced ovarian cancer (AOC) undergoing a cytoreductive surgery are unknown. We aimed to evaluate the feasibility of a multimodal prehabilitation program in patients with AOC and its impact on postoperative outcomes.Methods We prospectively compared 15 patients with AOC stage scheduled to undergo a citorreductive surgery between December 2019 and January 2021 after a multimodal prehabilitation program consisting of supervised exercise training, nutritional optimization and psychological preparation versus a control cohort of 19 patients matched according to clinical and surgical characteristics who underwent surgery without prehabilitation between January 2018 and November 2019. In both groups, the enhanced recovery after surgery guidelines were followed. We analyzed adherence to the program, comprehensive complication index (CCI), hospital length of stay, and time to starting chemotherapy. Results Overall adherence to the multimodal prehabilitation program was 80%, with 86.7% adherence to exercise training, 100% adherence to nutritional optimization, and 80% adherence to psychological preparation. Median hospital stay was shorter in the prehabilitation cohort [5 days (IQR, 4-6) vs. 7 days (IQR,5-9) in the control cohort, p=0.04]. CCI score in the prehabilitation cohort was 9.3 (SD 12.12) vs. 16.61 (SD 16.89) in the control cohort, p=0.2. Median time to starting chemotherapy was shorter in the prehabilitation cohort compared to control cohort [25 days (IQR, 23-25) vs. 35 days (IQR 28-45), p=0.03]. Conclusion Multimodal prehabilitation is feasible and safe in patients with AOC. This study found significantly shorter hospital stays and time to starting chemotherapy in the multimodal prehabilitation cohort.

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Section: Results In the Context Of Published Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility of a Multimodal Prehabilitation Program in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer: a Pilot Study

Díaz-Feijoó¹,

Agustí²,

Sebio³

et al. 2021

Preprint

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“…2 The peritoneal cancer index is now broadly used for several cancers, including ovarian cancer. 3 This index is commonly assessed by diagnostic laparoscopy before cytoreductive surgery to adapt the treatment strategy and guide the surgical decision. 4 However, the peritoneal cancer index is subject to variability between surgeons and teams, and there is no validated cut-off value for neoadjuvant treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The peritoneal cancer index was proposed in 1996 by Professor Sugarbaker,1 and was initially used for colon cancer to assess the tumor burden during laparotomy procedures 2. The peritoneal cancer index is now broadly used for several cancers, including ovarian cancer 3. This index is commonly assessed by diagnostic laparoscopy before cytoreductive surgery to adapt the treatment strategy and guide the surgical decision 4.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal cancer index: laparoscopic evaluation of peritoneal carcinomatosis from gynecological origin

Daix

Ángeles

Motton

et al. 2022

Int J Gynecol Cancer

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“…They defined a cut-off PCI score < 25 to be favorable for CCR (in colorectal cancer, the cut-off is defined as PCI < 20 [ 12 ]). Angeles et al [ 13 ] showed that even if the laparoscopic assessment underestimated the final PCI score in EOC by 2 points compared to laparotomy, CCR and laparoscopic PCI were significantly associated. If successful cytoreductive surgery is not expected in a patient (PCI > 25), a neoadjuvant therapy concept should be considered to reduce the tumor burden followed by an interval debulking surgery (IDS) [ 5 , 11 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

The importance of the Peritoneal Cancer Index (PCI) to predict surgical outcome after neoadjuvant chemotherapy in advanced ovarian cancer

Rawert

Luengas-Würzinger

Spee

et al. 2022

Arch Gynecol Obstet

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Purpose Achieving complete cytoreduction (CCR) is crucial for a patient’s prognosis with advanced epithelial ovarian cancer (EOC). So far, prognostic predictors have failed to predict surgical outcome after neoadjuvant chemotherapy (NACT). In clinical trials, scores were used to predict operability in recurrent ovarian cancer (Harter et al. in N Engl J Med 385(23):2123–2131, 2021) but there is no known prediction score for CCR after NACT. The Peritoneal Cancer Index (PCI) is an established tool to predict surgical outcome in primary setting (Lampe et al. in 25:135–144, 2015). We now examined the predictive power of the PCI to achieve CCR after NACT. Methods In this single-center study, the data of patients with advanced stage EOC (FIGO > IIIb) treated between 01/2015 and 12/2020 were analyzed retrospectively. Inclusion criteria were a mandatory staging laparoscopy, a PCI score > 25, and NACT. CT scans were analyzed in blinded fashion according to RECIST criteria (Borgani et al. in 237; 93–99, 2019) Reaction of PCI after NACT was compared with the analysis of radiologic imaging and CA-125 levels. Results Three hundred and sixteen patients were screened, 62 were treated with NACT, and 23 were included in our analysis. 87% of cases presented with an FIGO IIIc stadium. The reduction of PCI itself after NACT showed to be the most powerful predictor for achieving CCR. The reduction of the initial PCI score by minimum of 8.5 points was a better predictor for CCR than reaching a PCI < 25. In contrast to data deriving from patients undergoing primary debulking surgery (PDS), we found a PCI of 17, rather than 25, to be a more valuable cut-off for CCR in neoadjuvant-treated patients. Conclusion The extend of PCI reduction after NACT is a better predictor for achieving CCR compared with CA125 levels and radiologic imaging. The PCI must be assessed differently in neoadjuvant setting than in a primary situation. CCR was most likely for a post-NACT PCI < 17.

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

Cited by 10 publications

References 34 publications

Feasibility of a Multimodal Prehabilitation Program in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer: a Pilot Study

Feasibility of a Multimodal Prehabilitation Program in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer: a Pilot Study

Peritoneal cancer index: laparoscopic evaluation of peritoneal carcinomatosis from gynecological origin

The importance of the Peritoneal Cancer Index (PCI) to predict surgical outcome after neoadjuvant chemotherapy in advanced ovarian cancer

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