The role of the peritoneal carcinomatosis index in the treatment strategy for stage IIIc-IV serous ovarian cancer
Summary. Ovarian cancer (OC) is one of the most aggressive and complex diseases of the female genital area. More than 3500 new cases of the disease are registered annually in Ukraine, 22.7% of patients die within the first year after diagnosis. This indicates the relevance of the development of new and optimization of existing programs for the treatment of ovarian cancer. Aim. To analyze the results of treatment of patients with primary advanced serous ovarian cancer with a high index of peritoneal carcinomatosis (PCI ≥12) according to the following indicators: the degree of aggressiveness of the surgical intervention, postoperative complications, the length of stay in the intensive care unit and hospital, the timing of chemotherapy initiation, in comparison with the group of patients with low PCI (<12) after cytoreductive surgery. Materials and methods. The results of treatment of 50 patients with advanced serous ovarian cancer who were treated at the Department of Oncogynecology of the National Cancer Institute from 2016 to 2020 were analyzed. The Surgical Complexity Scoring System was used to estimate the volume of surgical procedures, which provides a quantitative assessment of each surgical procedure. 50 patients were divided into two groups equally depending on the value of the PCI: ≥12 — 25 patients — the study group and PCI <12 — 25 patients — the control group. Results. At the end of the 1st day of the postoperative period (POD-0), statistically significant changes (p<0.05) were found in аlanine aminotransferase and aspartate transaminase levels in patients with PCI ≥12, which indicates the development of liver dysfunction in this group. Pleurisy and severe anemia are the most frequent complications of the postoperative period, much more often (p<0.05) are found in patients with a high index of peritoneal carcinomatosis compared with the control group. A statistically significant difference (p<0.05) was found in the length of stay of patients in the intensive care unit and hospital between the study and control groups. Thus, patients with PCI ≥12 stayed in the intensive care unit and hospital after cytoreductive surgerysignificantly longer. Conclusions. The data obtained indicate that cytoreductive surgery in patients with a high index of peritoneal carcinomatosis is an extremely aggressive procedure, significantly disrupts the functioning of a number of organs and body systems, increases the number of surgical and non-surgical complications in the postoperative period, and lengthens the inpatient treatment of such patients. A high PCI (≥12) in combination with a dubious prospect of performing complete cytoreduction (the possibility of reaching the R0 level for a residual tumor), the presence of severe concomitant pathology are the criteria for choosing neoadjuvant polychemotherapy in the strategy of treatment of stage IIIc–IV ovarian cancer.
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