Preoperative clues to guide primary approach in advanced ovarian cancer (OC): The role of CT findings to predict the extent of tumor dissemination.

Abstract

e15541 Background: We previously demonstrated that surgical complexity combined with specific patient factors are key determinants of morbidity in OC treatment. Specifically, high tumor dissemination (HTD) is an important risk factor for poor outcome after primary surgery in medically compromised patients. Thus, reliable preoperative indicators of extent of disease are necessary for considering primary surgery vs. neoadjuvant chemotherapy. We sought to determine whether CT findings could predict extent of disease or surgical complexity in patients with advanced OC. Methods: Preoperative CT scans for patients diagnosed with advanced OC between 1997 and 2003 were retrospectively evaluated for the following rigorously defined findings: ascites; peritoneal thickening; involvement of large bowel, sigmoid colon, spleen, liver, omentum, diaphragm, and lymph nodes. These were compared to the findings at exploration and the surgical procedures performed. Fisher’s Exact test was used to assess correlations. Results: 46 cases met inclusion criteria. Mean age was 66.4 y, mean OR time was 228 min. and 65% had residual disease (RD) 1cm or less. CT findings correlated with positive surgical findings (sensitivity/specificity) as follows: diaphragm disease (48.4%/ 100%); parenchymal liver (100%/93.3%); omental cake (72.4%/64.7%); sigmoid colon (53.9%/100%); ascites (44.4%/100%); large bowel (28.6%/90.9%). When both diaphragm disease and omental cake were present, this predicted HTD(specificity=100%, sensitivity=40%). Additionally, there was strong correlation between CT findings and the corresponding surgical procedures necessary to remove disease: large bowel resection (p=0.079), liver resection (0.087). Conclusions: The findings of diaphragm disease and omental cake on CT scan are highly specific for high tumor dissemination (HTD) at surgical exploration. In addition, multiple CT findings correlate strongly with the need for corresponding high-risk surgical procedures which can be helpful in predicting surgical complexity. This pilot data suggests CT scan may be very useful in preoperative risk-prediction of primary surgical cytoreduction.