Computed Tomography Peritoneal Carcinomatosis Index’s Role In Selction For Ovarian Cancer Surgery: Definitive Guide Or Doubtful Tool

<p dir="ltr">Background</p><p dir="ltr">Although a lot of effort using imaging, selection tools, radiomics and artificial intelligence have been involved in the selection of Advanced Ovarian Cancer (AOC) patients for Cytoreductive Surgery (CRS), there are still no set standard criteria. Therefore, the use of Computed Tomography Peritoneal Carcinomatosis Index (CT PCI) as a tool for selecting AOC patients for CRS was explored in this study. Previous studies noted that there is potential in preoperative assessment with CT PCI to select AOC patients for CRS.</p><p dir="ltr">Aim</p><p dir="ltr">A double-blinded prospective cohort study was conducted involving AOC patients presenting to the University Hospitals of Leicester NHS Trust. The primary objective was to determine the correlation and agreement between CT PCI and surgical PCI in AOC patients and to evaluate whether CT PCI can be used as a selection tool for CRS in AOC patients. The effect of quality of life (QOL) on CRS in AOC patients was investigated by completing the EORTC/QLQ-30 questionnaire before the surgery and three months after CRS. The QOL questionnaire domains were divided into global health status, functional performance, and symptomatology.</p><p dir="ltr">Conclusion</p><p dir="ltr">The use of CT PCI as a tool for predicting intraoperative PCI and selecting AOC patients for CRS was explored in this study. Our study involved 26 AOC patients undergoing CRS: 17 patients underwent interval CRS and 9 patients underwent primary CRS. Complete cytoreduction (R0) was achieved in 57.7% of the patients and suboptimal cytoreduction (R1) was performed in 15.4% of the patients.</p><p dir="ltr">On comparing the preoperative CT PCI and surgical PCI, the level of correlation was found to be poor. Furthermore, the level of agreement was shown to be fair in regions 0 and 3: however, it was poor in other regions. Hence, we believe that CT PCI should not be used as a solitary tool for selection of AOC patients for CRS. Nineteen patients completed the QOL questionnaire before and after the surgery. Our study concluded that CRS intervention impaired physical functioning and worsened the patient's symptoms. However, the overall global health status was restored to baseline three months postoperatively.</p>