Peritoneal cancer index predicts severe complications after ovarian cancer surgery

Abstract

Introduction: prediction and importance of severe postoperative complications after ovarian cancer surgery is a strong issue in patient selection and evaluation. Pre-and early peroperative predictors of severe 30-days postoperative complications (Clavien-Dindo class !3) after surgery for primary ovarian cancer are not fully established, neither their impact on patients' survival. Materials and methods: A prospective observational study included 256 patients with primary ovarian cancer FIGO stages IIB-IV, operated during 2009e2018 in a primary or interval debulking surgery setting. Patient variables were analysed in relation to severe postoperative complications (Clavien-Dindo class !3) and overall survival. Results: High-grade postoperative complications occurred in 24.2% patients. Class 3a complications were observed in 12.5% cases. High-grade complications class !3 were observed in 31.6% after primary debulking surgery compared to 12.2% after interval debulking surgery (p ¼ 0.0004). Peritoneal cancer index !21 and preoperative albumin concentration 33 g/L were independent predictors of high-grade complications. Peritoneal cancer index correlated with the surgical complexity score and completeness of cytoreduction. Increased peritoneal cancer index was a negative predictor of overall survival, but highgrade complications did not influence survival negatively. Conclusions: Peritoneal cancer index !21 was an independent predictor of high-grade complications after ovarian cancer surgery. Increased peritoneal cancer index also impacted overall survival negatively, but high-grade complications did not influence overall survival.

Expanding the Use of HIPEC in Ovarian Cancer at Time of Interval Debulking Surgery to FIGO Stage IV and After 6 Cycles of Neoadjuvant Chemotherapy: A Prospective Analysis on Perioperative and Oncologic Outcomes

“…Neither FIGO stage at diagnosis nor number of received NACT cycles appeared to affect perioperative outcomes, even if women submitted to > 4 cycles of NACT showed a trend toward a more deranged postoperative creatinine serum level and longer median hospital stay, which can be explained by (i) the higher rate of small/large bowel resection perfomed in this popualtion, (ii) by the cumulative toxicity from chemotherapy, and/or (iii) by the usual higher rate of comorbidities and disease burden among women scheduled for prolonged NACT. 6 , 15 , 16 …”

Exploring the Survival Determinants in Recurrent Ovarian Cancer: The Role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

“…Lomnytska et al identified the PCI as an independent predictor of high-grade complications after ovarian cancer surgery, highlighting its clinical relevance in perioperative planning and patient counseling [ 42 ]. Furthermore, Jónsdóttir et al found the PCI to be an excellent predictor of operability and survival outcomes, with higher scores correlating with increased rates of complications and reduced chances of survival [ 43 ].…”

Risk factors of perioperative complications and management with enhanced recovery after primary surgery in women with epithelial ovarian carcinoma in a single center

“…Nowadays, gynecological oncologists emphasize the risk factors associated with perioperative complications such as malnutrition, hypoalbuminemia, low transferrin levels, obesity, insulin resistance, high levels of C-reactive protein, interleukin-6 and increased platelet count (36)(37)(38). Moreover, a peritoneal cancer index ≥21 and preoperative albumin concentration ≤33 g/l were also independent predictors of high-grade complications (37,39). Although the ERAS protocol can enhance the rehabilitation of a patient, a recent study showed that 5.8% of 7,029 patients (76.5% from Caucasian ethnicity) in the national surgical quality improvement program database had experienced Clavien-Dindo IV complications, and that 0.9% of patients died within 30 days.…”