The Predictive Model of Suboptimal Primary Debulking Surgery among Women with Ovarian Cancer Using Pre-Operative Computerized Tomography, Tumor Markers and Comparison with the Intraoperative Findings: An Experience in Tertiary Care Hospital of Pakistan.

Objective: Ovarian cancer is reported to be one of the most morbid gynecological cancers, often diagnosed at advanced stages. Primary debulking surgery (PDS) along with chemotherapy is the treatment of choice; however, there is a high probability of suboptimal excision. Thus, each patient should be evaluated for the appropriate treatment modality and PDS should be deferred as the risk of surgical complications and delay in chemotherapy consequently impacts survival. It is imperative to formulate a predictive model to select patients for optimal debulking surgery.

Methods: A prospective observational study was conducted on women with ovarian cancer who underwent PDS at Indus Hospital and Health Network (IHHN), Pakistan from March 1st, 2020 till June 30th, 2024. Data was analyzed using SPSS 20.0. Chi-Square test was used to find the association between the predictors of optimal and sub-optimal debulking surgery using pre-operative computed tomography (CT) scan findings, and serum tumor markers. The sensitivity and specificity of serum cancer antigen 125 (CA-125) levels were measured.

Results: A total of 65 women with ovarian tumors were recruited in the study. Around 90.7% of patients had optimal PDS while 9.2% of patients underwent suboptimal PDS. Using pre-operative predictive scoring criteria, 48 (73.8%) patients scored 0-5 and all had optimal PDS while 11 (16.9%) patients scored 6-8, out of which 9 had suboptimal PDS (P value 0.00). A predictive score of 9 or more was reported in 6 (9.2%) patients, out of which 4 had suboptimal PDS.

Conclusion: This study proposed a predictive model using pre-operative CT scan criteria and tumor marker serum CA-125 level which will help in scoring the patients with epithelial ovarian cancer. Subsequent treatment options should be decided either in the form of upfront debulking surgery or neoadjuvant chemotherapy. Further prospective studies are required to formulate a better applicable predictive model in all types of ovarian cancer including germ-cell ovarian tumors and sex cord-stromal tumors.