Prognostic Value of En-Block Radical Bowel Resection in Advanced Ovarian Cancer Surgery With HIPEC.

PURPOSE: To identify prognostic factors of survival and recurrence in advanced ovarian cancer patients undergoing radical surgery and HIPEC. METHODS: In a single Department of Surgical Oncology, Peritoneal Surface Malignancy Program, and over a 16-year period, from a total of 274 epithelial ovarian cancer patients, retrospectively, we identified 152 patients undergoing complete (CC-0) or near-complete (CC-1) cytoreduction, including at least one colonic resection, and HIPEC. RESULTS: Mean age of patients was 58.8 years and CC-0 was possible in 72.4%. Rates of in-hospital mortality and major morbidity were 2.6% and 15.7%. Only 122 (80.3%) patients completed Adjuvant Systemic Chemotherapy (ASCH). Rates of metastatic Total Lymph Nodes (TLN), Para-Aortic and Pelvic Lymph Nodes (PAPLN) and Large Bowel Lymph Nodes (LBLN) were 58.7%, 58.5%, and 51.3%, respectively. Median, 5- and 10-year survival rates were 39 months, 43%, and 36.2%, respectively. The recurrence rate was 35.5%. On univariate analysis, CC-1, high Peritoneal Cancer Index (PCI), in-hospital morbidity, and no adjuvant chemotherapy were adverse factors for survival and recurrence. On multivariate analysis, negative survival indicators were the advanced age of patients, extensive peritoneal dissemination, low total number of TLN and no systemic PAPLN. Metastatic LBLN and segmental resection of the small bowel (SIR) were associated with a high risk for recurrence. CONCLUSION: CC-O is feasible in most advanced ovarian cancer patients and HIPEC may confer a survival benefit. Radical bowel resection, with its entire mesocolon, may be necessary, as its lymph nodes often harbor metastases influencing disease recurrence and survival. The role of metastatic bowel lymph nodes has to be taken into account when assessing the impact of systemic lymphadenectomy in this group of patients.

Cytoreductive surgery and HIPEC improve survival compared to palliative chemotherapy for biliary carcinoma with peritoneal metastasis: A multi-institutional cohort from PSOGI and BIG RENAPE groups.

BACKGROUND: Peritoneal metastasis from biliary carcinoma (PMC) is associated with poor prognosis when treated with chemotherapy. OBJECTIVE: To evaluate the impact on survival of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and compare with conventional palliative chemotherapy for patients with PMC. MATERIAL AND METHODS: A prospective multicenter international database was retrospectively searched to identify all patients with PMC treated with a potentially curative CRS/HIPEC (CRS/HIPEC group). The overall survival (OS) was compared to patients with PMC treated with palliative chemotherapy (systemic chemotherapy group). Survival was analyzed using Kaplan-Meier method and compared with Log-Rank test. RESULTS: Between 1995 and 2015, 34 patients were included in the surgical group, and compared to 21 in the systemic chemotherapy group. In the surgical group, median peritoneal cancer index was 9 (range 3-26), macroscopically complete resection was obtained for 25 patients (73%). There was more gallbladder localization in the surgical group compared to the chemotherapy group (35% vs. 18%, p = 0.001). Median OS was 21.4 and 9.3 months for surgical and chemotherapy group, respectively (p=0.007). Three-year overall survival was 30% and 10% for surgical and chemotherapy group, respectively. CONCLUSION: Treatment with CRS and HIPEC for biliary carcinoma with peritoneal metastasis is feasible and may provide survival benefit when compared to palliative chemotherapy.

Docetaxel plus gemcitabine in combination with capecitabine as treatment for inoperable pancreatic cancer: a phase II study.

PURPOSE: To evaluate the activity and tolerance of gemcitabine in combination with docetaxel and capecitabine in previously untreated patients with advanced pancreatic cancer. PATIENTS AND METHODS: Chemotherapy-naïve patients with locally advanced or metastatic pancreatic cancer were treated with gemcitabine (1,500 mg/m(2) on days 1 and 15), docetaxel (50 mg/m(2) on days 1 and 15) and capecitabine (2,250 mg/m(2), orally in two daily divided doses, on days 1-7 and 15-21). All three drugs were administered in 4-week cycles, in an initial prospective plan of six cycles. The primary end-point was response rate. RESULTS: Forty patients were enrolled in the study. At the time of enrollment, 40% of patients had locally advanced and 60% metastatic disease. All patients were evaluable for response and toxicity. On an intent-to-treat analysis, the overall response and disease control rates were 40 and 80%, respectively. The median progression-free survival was 6.0 months, and the median overall survival was 9.0 months. Major grade 3/4 toxicities were neutropenia (17.5%), diarrhea (10%) and hand-foot syndrome (7.5%). There was no treatment-related death. CONCLUSION: The combination of gemcitabine with docetaxel and capecitabine is feasible and exhibits satisfactory degree of activity in patients with advanced pancreatic cancer, deserving further exploration.

The cost of cytoreductive surgery and perioperative intraperitoneal chemotherapy in the treatment of peritoneal malignancy in one Greek institute.

PURPOSE: Cytoreductive surgery and perioperative intraperitoneal chemotherapy in the treatment of patients with peritoneal malignancy is expensive. The purpose of this study was to estimate the current cost of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy and identify the most significant related parameters in one center in Greece. METHODS: A retrospective economic study was carried out on 105 patients that underwent 108 cytoreductive operations and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) from 2006-2011 for peritoneal malignancy. The economic cost included the daily cost of hospital bed occupancy, the daily cost of occupancy in the intensive care unit (ICU), the expenditures (materials and drugs), and the preoperative, intraoperative, and postoperative examinations. RESULTS: The mean length of stay in the ICU and the mean hospitalization time was 5 and 23 days, respectively. The hospital mortality and morbidity was 5.6% (6 patients) and 48.17percnt; respectively. The mean cost of treatment was 15677.3±11910.6 euros (range=4258,47-95990,87) per patient. Morbidity (p=0.009), and prolonged stay in the ICU (p<0.001) were the parameters that influenced independently the cost of treatment. CONCLUSION: Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy is an expensive treatment. The economic cost is largely influenced by morbidity and the length of stay in the ICU.

Adjuvant perioperative intraperitoneal chemotherapy in locally advanced colorectal carcinoma: preliminary results.

Background and Aims. Intraperitoneal chemotherapy is a basic tool in the treatment of peritoneal malignancy. The purpose of the study is to investigate the effect of adjuvant perioperative intraperitoneal chemotherapy in the treatment of locally advanced colorectal cancer. Patients and Methods. Patients with T(3) and T(4) colorectal carcinomas that underwent R(0) resection received either hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC group = 40 patients) or early postoperative intraperitoneal chemotherapy (EPIC group = 67 patients). The survival, the recurrences and the sites of recurrence were assessed. Results. The 3-year survival rate for HIPEC group was 100% and for EPIC group 69% (P = .011). Nodal infiltration was found to be the single prognostic indicator of survival. The incidence of recurrence in EPIC group was higher than in HIPEC group (P = .009). The independent indicators of recurrence were the use of HIPEC and the degree of differentiation (P < .05). Conclusions. Intraperitoneal chemotherapy, particularly HIPEC, as an adjuvant in locally advanced colorectal carcinomas appears to improve survival and decrease the incidence of recurrence.

Docetaxel plus oxaliplatin in combination with capecitabine as first-line treatment for advanced gastric cancer.

OBJECTIVE: In the present phase II study, we evaluated the efficacy and safety of a docetaxel-oxaliplatin-capecitabine combination as a first-line treatment in patients with advanced gastric cancer. PATIENTS AND METHODS: A total of 27 patients (18 males) with histologically confirmed inoperable gastric adenocarcinoma were recruited. Docetaxel was given (50 mg/m(2) i.v.) on day 1 followed by oxaliplatin (75 mg/m(2) i.v.) also on day 1. Capecitabine (2,750 mg/m(2)) was given orally as two daily divided doses from days 1 to 7. Cycles were repeated every 2 weeks. All patients had measurable disease and 18 of them had a performance status (WHO) of 0. RESULTS: A total of 240 treatment cycles were administered. All patients were evaluable for toxicity. Four patients who discontinued treatment early (having received only 3 chemotherapy cycles) were included as non-responders in an intention-to-treat response analysis. Complete response, partial response, stable disease and progressive disease were observed in 4 (15%), 12 (44%), 3 (11%) and 8 (30%) patients, respectively. The observed response rate was 59%, and the disease control rate (complete response + partial response + stable disease) was 70%. At the time of analysis, 6 patients were still alive and the median survival was 18.0 months. The most common grade III/IV toxicities observed were neutropenia (5%), diarrhea (2%), palmar-plantar erythrodysesthesia (2%) and neurotoxicity (1%). All other toxicities were mostly of grade I/II and easily manageable. CONCLUSION: The combination of docetaxel, oxaliplatin and capecitabine in the described mode of administration represents a relatively active and well-tolerated regimen in patients with advanced gastric cancer and warrants further evaluation.

Biweekly vinorelbine and gemcitabine as second-line and beyond treatment in ovarian cancer.

PURPOSE: To evaluate the activity and tolerance of vinorelbine (VRL) in combination with gemcitabine (GEM) in pre-treated patients with refractory ovarian cancer. PATIENTS AND METHODS: Seventeen patients with ovarian cancer who had disease progression after a carboplatin and taxane front-line regimen were treated with VRL 30 mg/m(2) IV over 10 min followed by GEM 1,200 mg/m(2) IV over 30 min on days 1 and 15 of each 28 days cycle. Chemotherapy was given in a initial prospective plan of six cycles, unless disease progression or unacceptable toxicity was seen, giving more cycles as consolidation therapy in the case of CR, PR or SD. The median age of patients was 67 years old, and the performance status (WHO) was 1 for 13 and 2 for 4 patients. The treatment was second-line for 11 (65%) and >third-line for 6 (35%) patients. RESULTS: One complete and one partial response were observed (ORR:11%). Stable disease was seen in 4 (24%) patients and progressive disease in 11 (65%). The median time to tumor progression was 4 months (range 2-11), and the median survival has not yet been reached. Myelotoxicity was rare. Grade 1 neutropenia was observed just in one patient and grade 2/3 anemia in four patients (24%). Thrombocytopenia was absent. Non-hematologic toxicity was also predictable and easily manageable. CONCLUSION: The vinorelbine plus gemcitabine combination at the present doses and schedule is a safe but ineffective regimen, and therefore, is not recommended as second-line and beyond treatment in patients with refractory ovarian cancer.

Long-term results following potentially curative gastrectomy for gastric cancer.

PURPOSE: The purpose of this study was to report the results of gastric cancer surgery in patients who had undergone potentially curative gastrectomy. METHODS: The hospital mortality, morbidity, survival, recurrences and the sites of failure were retrospectively analyzed in D1 group (conventional gastrectomy), and in D2 group (extended lymph node resection). RESULTS: D1 and D2 groups were comparable for age, gender, American Society of Anesthesiologists (ASA) class, type of surgery, and histopathologic characteristics (p>0.05). D2 group patients were in better physical status (p=0.008). The recurrence rate was higher in D1 group (p=0.019). Independent prognostic indicators of morbidity were male gender (p=0.012), and poor ASA class (p<0.001). Poor ASA class was the single independent prognostic indicator of hospital mortality (p=0.001). Ten-year survival for D1 and D2 was 44.1 and 64.8%, respectively (p=0.0433). D2 gastrectomy improved survival in stage IIIA. The independent prognostic indicators of survival were total gastrectomy (p=0.003), lymph node involvement (p<0.0001), and extended lymphadenectomy (p=0.003). The independent prognostic variables of recurrence were stage (p=0.001), and extended lymph node resection (p=0.006). CONCLUSION: D2 gastrectomy improves survival in gastric cancer, particularly in stage IIIA.

Differences between right- and left-sided colon carcinomas.

PURPOSE: Clinical, histopathological, and biological differences between right and left colon carcinomas have been questioned in the literature. The purpose of this retrospective study was to identify possible clinical and histopathological differences between the right and left colon carcinomas. METHODS: From 1987-2007, 109 patients with right colon carcinomas (RC group), and 186 patients with left colon carcinomas (LC group) were treated at a single institution. Clinical, histopathological, and biological variables were correlated to tumor location. The endpoint of the study was to see for any relationship between overall survival, recurrences, and their pattern in regard to tumor location. RESULTS: The incidence of distant metastases at initial diagnosis (p=0.049), and poorly differentiated tumors (p=0.001) was higher in right colon carcinomas. The 10-year survival rate in the RC group was 63% and in the LC group 66% (p >0.05). Recurrences, sites of recurrence, the in-hospital mortality and morbidity were similar in both groups (p >0.05). CONCLUSION: The biological behavior of right and left colon carcinomas is similar despite minor histopathological differences that do not influence survival and development of recurrences.

The impact of total mesorectal excision in middle and low rectal carcinomas.

PURPOSE: The incidence of locoregional recurrence in rectal cancer has declined since total mesorectal excision (TME) has been widely adopted. The purpose of this study was to investigate the long-term survival and the incidence of locoregional recurrences in patients with middle and low rectal carcinomas undergoing TME. METHODS: The medical records of 126 patients with middle and low rectal carcinomas treated from 1987-2007 were retrospectively reviewed. Of them 80 had undergone total mesorectal excision (TME-group) and 46 surgery with conventional methods (CON-group). Clinical variables were correlated to morbidity, hospital mortality, recurrence, sites of recurrence, and survival. RESULTS: The groups were comparable except for type of surgery and sites of recurrence. Five-year overall survival rate for TME group was 75% and for CON-group 47% (p=0.0346). Although the groups were not different for the total number of recurrences, the number of locoregional recurrences was significantly lower in TME group (p=0.004). CONCLUSION: TME appears to improve long-term survival in patients with middle and low rectal carcinomas. The incidence of locoregional recurrence is also reduced by TME.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal carcinomatosis. Preliminary results and cost from two centers in Greece.

PURPOSE: To report our preliminary experience in the combined treatment of peritoneal carcinomatosis (PC) using cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). PATIENTS AND METHODS: This prospective study included patients with PC from gynaecological, gastric and colon cancer, treated in two centers. Cytoreductive surgery included the peritonectomy procedures described by Jacquet and Sugarbaker as well as multivisceral resections in order to achieve a complete macroscopical cancer eradication. The HIPEC that followed was performed via the open abdomen technique. RESULTS: Twenty-four patients (3 men and 21 women, mean age 60 years) were treated. Twelve patients had PC from ovarian cancer, 7 from colon, 3 from gastric and 2 from uterine cancer. The mean duration of the procedure was 7.83 h (range 5 -12.30). Macroscopically, complete cytoreduction (CC) was achieved in 18 (75%) patients. Two (8.3%) patients died in the first 30 days. The overall morbidity was 42% and 2 patients were reoperated. The mean follow up was 22 months (range 3-36). The overall 1-year survival was 59.1%; concerning the gynaecological cancers it was 53.8% (mean survival 11.7 months) and for gastrointestinal cancers it was 44.4% (mean survival 9.5 months). CONCLUSION: Our preliminary data suggest that the combined treatment of cytoreduction plus HIPEC for PC is associated with acceptable mortality and morbidity and offers an improved survival in these patients. An optimal patient selection and establishment of experienced centres are of paramount importance.

Long-term survival in advanced ovarian carcinoma following cytoreductive surgery with standard peritonectomy procedures.

The impact of cytoreductive surgery with standard peritonectomy procedures has not been extensively assessed in the treatment of advanced ovarian cancer. The aims of the study are to report the long-term results of patients with advanced ovarian cancer undergoing cytoreductive surgery with standard peritonectomy procedures and to identify the prognostic indicators that may affect outcome. The records of 74 women with advanced ovarian cancer were retrospectively reviewed. Clinical indicators were correlated to survival. The hospital mortality and morbidity rates were 13.5% and 28.4%, respectively. Complete or near-complete cytoreduction was possible in 78.4% of the patients. Overall 10-year survival rate was 52.5%. Complete cytoreductive surgery, small-volume tumor, low-grade tumor, the absence of distant metastases, the use of systemic adjuvant chemotherapy, performance status >70%, and limited extent of peritoneal carcinomatosis were favorable indicators of survival. Complete cytoreduction (P= 0.000) and treatment with systemic chemotherapy (P= 0.001) independently influenced survival. Recurrence was recorded in 37.8% of the patients and was independently influenced by the tumor grade (P= 0.037). Cytoreductive surgery with standard peritonectomy procedures followed by adjuvant chemotherapy offers long-term survival in women with advanced ovarian cancer who have limited peritoneal carcinomatosis and no distant and irresectable metastases.

A dose escalation study of docetaxel plus capecitabine in combination with gemcitabine in patients with advanced solid tumors.

Capecitabine (CAP), gemcitabine (GEM), and docetaxel (DOC) have shown interesting activity in a wide range of solid tumors. A phase I study was conducted in order to determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of their combination in patients with refractory solid tumors. Eighteen patients were enrolled. The patients' median age was 60 years, 15 were male, and 11 were chemo-naive. DOC was administered on day 1 as an 1-h (IV) infusion at escalating doses ranging from 40 to 50 mg/m2. GEM was administered on day 1 as a 30-min (IV) infusion at a standard dose of 1500 mg/m2. CAP was administered orally on days 1 to 7 at escalating doses ranging from 1750 to 2500 mg/m2 given as two daily divided doses. Treatment was repeated every 2 weeks. Five different dose levels were examined. At dose level V two out of three enrolled patients presented DLTs (one patient grade 4 neutropenia and grade 3 stomatitis and another grade 3 diarrhea), and thus the recommended MTD for future phase II studies are CAP 2250 mg/m2, DOC 50 mg/m2, and GEM 1500 mg/m2. A total of 124 treatment cycles were administered. Toxicity was generally mild. Grade 3/4 neutropenia was observed in eight (7%) treatment cycles and grade 3 thrombocytopenia in one (1%). There was no febrile episode. Grade 2/3 asthenia was observed in six (33%) patients, grade 2/3 diarrhea in four (22%), and grade 2/3 hand-foot syndrome in three (17%). Other toxicities were uncommon. There was no treatment-related death. One (6%) CR, four (25%) PRs, and six (38%) SD were observed among 16 evaluable patients. Responses were seen in patients with breast (one CR), gastric (three PRs), and pancreatic (one PR) cancer. These results demonstrate that CAP, DOC, and GEM can be safely combined at clinically relevant doses and this regimen merits further evaluation.

Long-term results of surgical treatment of hydatid disease.

BACKGROUND/AIMS: Non-radical surgery is the preferred method of treatment of hydatid liver disease, and is associated with low mortality and recurrence rate. The purpose of the study is the retrospective analysis of the outcome of patients who were treated surgically in a single institution. MATERIAL AND METHODS: Between 1987 and 2005, 59 patients, mean age 58.2 +/- 15.9 (13-83) years, underwent surgery for liver hydatid disease. The patients were reassessed with physical examination, serological tests and radiological examination for the evaluation of the recurrence rate. RESULTS: Most cysts were solitary, the more frequently affecting the right lobe of the liver. Radical surgery was possible in four cases (6.8%) that were classified as PNM stage I. Partial cystectomy and omentoplasty was performed in 37 patients (62.7%) and external drainage with partial cystectomy in 18 patients (30.5%). The hospital morbidity was 27.2% and was found to be related to ASA class (p = 0.019). Hospital mortality was 5.1%. The median follow-up time was 94 (1-228) months and 45 out of 59 patients (76.3%) were reassessed, but no recurrence was recorded. There was no significant difference in morbidity, mortality, and hospital stay between partial cystectomy combined with external drainage or omentoplasty (p > 0.05). CONCLUSIONS: PNM staging seems to be a reliable tool in selecting patients with liver hydatid disease for non-radical or radical surgery. Omentoplasty is an easy and effective surgical method for the treatment of hepatic echinococcosis but is not different than partial cystectomy and external drainage in regard to morbidity, mortality, and recurrence.

Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study.

PURPOSE: The three principal studies dedicated to the natural history of peritoneal carcinomatosis (PC) from colorectal cancer consistently showed median survival ranging between 6 and 8 months. New approaches combining cytoreductive surgery and perioperative intraperitoneal chemotherapy suggest improved survival. PATIENTS AND METHODS: A retrospective multicenter study was performed to evaluate the international experience with this combined treatment and to identify the principal prognostic indicators. All patients had cytoreductive surgery and perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy). PC from appendiceal origin was excluded. RESULTS: The study included 506 patients from 28 institutions operated between May 1987 and December 2002. Their median age was 51 years. The median follow-up was 53 months. The morbidity and mortality rates were 22.9% and 4%, respectively. The overall median survival was 19.2 months. Patients in whom cytoreductive surgery was complete had a median survival of 32.4 months, compared with 8.4 months for patients in whom complete cytoreductive surgery was not possible (P <.001). Positive independent prognostic indicators by multivariate analysis were complete cytoreduction, treatment by a second procedure, limited extent of PC, age less than 65 years, and use of adjuvant chemotherapy. The use of neoadjuvant chemotherapy, lymph node involvement, presence of liver metastasis, and poor histologic differentiation were negative independent prognostic indicators. CONCLUSION: The therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy achieved long-term survival in a selected group of patients with PC from colorectal origin with acceptable morbidity and mortality. The complete cytoreductive surgery was the most important prognostic indicator.

The development of bone metastases as the first sign of metastatic spread in patients with primary solid tumours.

The purpose of this retrospective study was to investigate the incidence of bone metastases as the first sign of metastatic spread in patients with primary solid malignant tumours. Between January 1987 and December 1998, we treated 867 patients suffering from primary solid malignant tumours. Their average age was 67 (range: 30-96) years and all were thoroughly investigated with a complete physical examination and laboratory tests as well as imaging studies and bone scans. No bone metastases were found at the time of the initial diagnosis, and the patients were then re-assessed every 6 months for the first 5 years and then once a year. We found that, regardless of treatment, bone metastases appeared in a certain number of patients and that after excluding patients with prostate cancer a bone metastasis was the first sign of "recurrence" in 1.3% of the patients with a known primary solid malignant tumour.

Oophorectomy during surgery for colorectal carcinoma.

BACKGROUND: The purpose of the study is to identify the effect of synchronous prophylactic oophorectomy in women undergoing colorectal cancer surgery on long-term survival, recurrences and sites of failure. PATIENTS AND METHODS: From 1987 to 2003, 124 women, mean age 69+/-10 (35-91) years, with colorectal carcinoma were retrospectively reviewed. In 70 (56.5%) women the ovaries were preserved during surgery and 54 (43.5%) women underwent synchronous prophylactic oophorectomy during primary tumour resection. Univariate and multivariate analysis were used to assess the effect of oophorectomy on long-term survival, recurrences and sites of failure. RESULTS: By univariate analysis it was demonstrated that synchronous oophorectomy had no effect on long-term survival (p=0.7294). By multivariate analysis it was demonstrated that stage was the only factor independently influencing survival (p=0.0061). Twenty-eight patients (23%) developed recurrence and 10 of them developed locoregional recurrence. By univariate analysis it was demonstrated that the number of recurrences was not different between women with or without oophorectomy (p=0.259). Distant and locoregional recurrences were not different between women undergoing resection of primary colorectal carcinoma with or without oophorectomy (p=0.611). CONCLUSIONS: Oophorectomy does not appear to influence long-term survival, the total number of recurrences or the sites of failure.

The management of peritoneal surface malignancy of colorectal cancer origin.

Colorectal carcinomas are predominantly spread malignancies. Peritoneal carcinomatosis frequently associates colorectal carcinomas. The tumour grade, the completeness of cytoreduction, the tumour volume, the presence of distant metastases, prior surgery score and the extent of peritoneal implantations are prognostic clinical features of survival. The management of colorectal cancer with peritoneal carcinomatosis is possible by resection of tumour, cytoreduction and intraperitoneal chemotherapy. T3 and T4 colorectal tumours are at risk of developing locoregional recurrence and may be treated by intraperitoneal chemotherapy. Early postoperative intraperitoneal chemotherapy has been used in 40 patients with T3 and T4 tumours, with 15% hospital mortality, and 32.5% morbidity. The overall 3-year survival rate was over 80% and only 15% distant metastases were recorded.

Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer.

AIM: The peritoneal cancer index (PCI) has been used for the detailed evaluation of the peritoneal spread in tumors of gastrointestinal origin and has been found to be a prognostic indicator of survival. The aim of this study was the identification of the significance of the peritoneal cancer index in advanced ovarian cancer. METHODS: From 1990 to 2001, 60 women, mean age 65+/-10.84 (41-86), were treated for advanced ovarian cancer. The performance status (Karnofsky performance scale), age, prior surgery score (PSS), peritoneal cancer index (PCI), tumor volume, tumor grade, residual tumor, the presence of ascites, treatment with adjuvant chemotherapy, histopathologic subtype and FIGO stage were retrospectively correlated to survival using univariate model of statistical analysis. RESULTS: Hospital mortality and morbidity were 11.7 and 16.7% respectively. The recurrence rate was 23.3%. Overall 5-year survival rate was 41% and mean survival 63+/-8 months. The peritoneal cancer index was related to survival (P=0.0253). The other favorable clinical prognostic indicators of survival were low grade and small volume tumors, treatment with adjuvant chemotherapy and complete cytoreductive surgery (P<0.05). CONCLUSIONS: The peritoneal spread in advanced ovarian cancer can be assessed in detail using the peritoneal cancer index. It is a significant prognostic factor of survival and is useful in identifying subgroups.