Definition of a dynamic laparoscopic model for the prediction of incomplete cytoreduction in advanced epithelial ovarian cancer: Proof of a concept

• The chance of achieving complete PDS in women with AEOC showing a LPS-PIV ≥ 10 was 0.
• The risk of unnecessary laparotomy in patients showing a LPS-PIV < 10 was 33.2%.
• The overall discriminating performance of LPS-PI was very high, with an AUC = 0.885.

ObjectiveTo develop an updated laparoscopy-based model to predict incomplete cytoreduction (RT > 0) in advanced epithelial ovarian cancer (AEOC), after the introduction of upper abdominal surgery (UAS).Patients and methodsThe presence of omental cake, peritoneal extensive carcinomatosis, diaphragmatic confluent carcinomatosis, bowel infiltration, stomach and/or spleen and/or lesser omentum infiltration, and superficial liver metastases was evaluated by staging laparoscopy (S-LPS) in a consecutive series of 234 women with newly diagnosed AEOC, receiving laparotomic PDS after S-LPS. Parameters showing a specificity ≥ 75%, PPV ≥ 50%, and NPV ≥ 50% received 1 point score, with an additional one point in the presence of an accuracy of ≥ 60% in predicting incomplete cytoreduction. The overall discriminating performance of the LPS-PI was finally estimated by ROC curve analysis.ResultsNo-gross residual disease at PDS was achieved in 135 cases (57.5%). Among them, UAS was required in 72 cases (53.3%) for a total of 112 procedures, and around 25% of these patients received bowel resection, excluding recto-sigmoid resection. We observed a very high overall agreement between S-LPS and laparotomic findings, which ranged from 74.7% for omental cake to 94.8% for stomach infiltration. At a LPS-PIV ≥ 10 the chance of achieving complete PDS was 0, and the risk of unnecessary laparotomy was 33.2%. Discriminating performance of LPS-PI was very high (AUC = 0.885).ConclusionsS-LPS is confirmed as an accurate tool in the prediction of complete PDS in women with AEOC. The updated LPS-PI showed improved discriminating performance, with a lower rate of inappropriate laparotomic explorations at the established cut-off value of 10.