STUDY OF AGE, PERFORMANCE STATUS, PERITONEAL CARCINOMATOSIS INDEX, BOWEL RESECTION AND HISTOPATHOLOGY IN ADVANCED EPIHELIAL OVARIAN CANCER.

Abstract

Objective –To study the Age, Peritoneal Carcinomatosis Index, Visceral Resection and Histopathology in FIGO stage III epithelial ovarian cancer. Methodology – A retrospective cross-sectional study was conducted at a tertiary hospital in Bangalore, India. All patients diagnosed with FIGO stage III epithelial ovarian cancer who underwent cytoreductive surgery (primary, interval or secondary cytoreductive surgery) between April 2017 to April 2019 were included in the study. Parameters noted were 1) Age at presentation 2) ECOG performance status 3) Peritoneal Carcinomatosis Index (PCI) 4) Visceral resection done 5) Histopathology report. Performance status was calculated according to European Co-operative Oncology Group (ECOG) grade. Histopathology report was grouped into four types. 1) Endometroid type 2) Low grade serous type 3) High grade serous type 4) Mucinous type. Histopathology reported as high-grade serous carcinoma with clear cell changes or high-grade dysplasia were included in high grade serous carcinoma type. Histopathology reported as high-grade serous carcinoma with clear cell changes or high-grade dysplasia were included in high grade serous carcinoma type. Results- A total of 84 patients were included in the study. 45 patients underwent interval, 25 patients underwent primary and 14 patients underwent secondary cytoreductive surgery. Most patients diagnosed with epithelial ovarian cancer was between age 50-70 years (65.46%). Maximum age noted was 82 years and minimum age noted was 36 years in this study. Most of the patients had ECOG performance status 1. 29.76% of patients had ECOG performance status 0, 65.47 % of patients had ECOG performance status 1 and 4.76% of patients had ECOG performance status 2. 45 patients underwent interval, 25 patients underwent primary and 14 patients underwent secondary cytoreductive surgery. Maximum PCI score noted was 36 and minimum PCI score noted was 3. Most of the patients had PCI score between 11-20 (66.66%) who underwent surgery. 26 patients out of 84 patients required bowel resection (30.95%). Most common bowel resection performed was anterior resections / low anterior resections followed by limited right hemicolectomy. 17.85% of patients underwent anterior resection and 5.95% of patients underwent limited right hemicolectomy. Other visceral resection done were limited left hemicolectomy (3.57%), transverse colectomy (1.19%), distal gastrectomy (1.19%), low anterior resection + limited right hemicolectomy (1.19%). None of the patients required diverting stoma. Anastomotic leak was noted in 3 patients (3.57%). Most common histopathology reported was high grade serous (71.44%) followed by low grade serous type (19.04%). Endometroid type and mucinous type was least common (4.76% each). Conclusion – Epithelial ovarian cancer was most common between age group 50-70 years in this study. Most patients had ECOG performance status 1. PCI score between range 11-20 was noted for majority of patients who underwent cytoreductive surgery. Most common bowel resection performed was low anterior resection/ anterior resection followed by limited right hemicolectomy. None of the patients required diverting stoma. Anastomotic leak was noted in 3.57% of patients. Most common histopathology reported was high grade serous (71.44%) followed by low grade serous type (19.04%). Endometroid type and mucinous type were least common (4.76% each)