Publications

Abstract Optimal cyto-reduction of advanced EOC has profound impact on the survival and prognosis of patients3. Suboptimal cytoreduction of advanced ovarian cancer is related to initial tumor bulk which indirectly correlates with serum CA125 levels. Can assessment of level of CA 125 in pre-opererative period predict optimal cyto-reduction is the aim of the study. The mean age of the 70 patients in this study was 49.9 years (SD- 11.75, Range: 21-69 years). Fourty four (63%) had stage III-ΙV disease. Sixty five (93%) patients had papillary serous ovarian cancer. The serum CA125 levels ranged from 6- 5300 U/ml with median preoperative serum CA-125 level for all the patients being 259 U/ml (IQR- 682.98U/ml). The level was elevated (>35 U/ml) in 49% of patients with stage Ι-Π compared with 93% of patients with stage Ш or ΙV disease. Optimal tumor cyto-reduction was obtained in 61/70 cases (87%) of total patients and in 35/44 (80%) of patients with stage III-ΙV disease. Diaphragmatic stripping, appendecetomy, recto-sigmoid resection and anastomosis, pelvic peritonectomy, peritoneal stripping/ debulking of peritoneal disease, hemi-colectomy, ileo colic anastomosis and partial nephrectomy. Most of our patients were in intermediate surgical complexity category with a score between 4-7. In 9 patients all belonging to advanced stage, sub-optimal cyto-reduction was done due to multiple co-morbidities, multiple mesenteric lymphnode involvement, multiple small bowel and liver parenchymal deposits and patient not willing for colostomy. An ROC curve analysis showed threshold value of CA125 of 411U/ml. With a cut-off of 411U/ml, 97% of total patients with CA125 levels lower than 411U/ml were able to undergo optimal cyto-reduction. Also, in 76% of patients with CA125 level more than 411U/ml optimal cyto-reduction could be achieved. When only advanced stages (stage III-IV) were considered, with a cut-off of 411U/ml, 88% of patients with CA125 levels lower than 411U/ml were able to undergo optimal cyto-reduction. Also, in 73% of patients with CA125 level more than 411U/ml optimal cyto-reduction could be achieved. With a pre-operative cut-off value of CA125 more than 411U/ml, the sensitivity, that is, probability to predict sub-optimal cyto-reduction was 65% and specificity, that is, probability to predict optimal cyto-reduction was only 67%. Which showed poor predictability for resectability which was in concordance with other studies. Though it is difficult to draw definite conclus Keywords: Carcinoma ovary, CA125, Cyto-reduction, Surgical complexicity score.