
Figure 1: Sugarbaker’s PCI chart
Case, S. No |
PCI | CCS | Cytoreductive procedures done | Morbidity mortality | ||||||
TAH+BS O+ RPLND |
Pelvic peritonectomy |
Diaphragm peritonectomy |
Bowel resection anastomosis (RA) |
Mesenteric deposits excision |
Splene ctomy |
Abdominal peritonectomy |
||||
1 | 13 |
2 |
Yes | Yes | Died on POD5, PTE | |||||
2 | 19 |
0 |
yes | Yes | Yes | Appen dicectomy |
Yes | Yes | ||
3 | 14 |
1 |
yes | Yes | Yes | Died on POD3, MI | ||||
4 | 10 |
0 |
yes | Yes | ||||||
5 | 34 |
2 |
yes | Yes | Yes | Yes | Yes | |||
6 | 21 |
1 |
yes | Yes | Yes | Yes | ||||
7 | 18 |
3 |
yes | IIeal- RA | SSI | |||||
8 | 21 |
2 |
yes | Appen dicectomy |
||||||
9 | 21 |
2 |
yes | Yes | Appen dicectomy |
|||||
10 | 15 |
1 |
Yes | Yes | Yes | Appen dicectomy |
SSI | |||
11 | 15 |
1 |
Yes | Yes | Appen dicectomy |
Yes | ||||
12 | 17 |
0 |
Yes | Yes | Yes | Yes | Yes | |||
13 | 5 |
0 |
Yes | Yes | ||||||
14 | 12 |
0 |
Yes | Yes | Yes | |||||
15 | 6 |
0 |
Yes | Yes | ||||||
16 | 13 |
0 |
Yes | Yes | Yes | Appen |
||||
17 | 17 |
1 |
Yes | Yes | Yes | Trans. colon -RA | ||||
18 | 18 |
1 |
Yes | Yes | Yes | Appen dicectomy |
Yes | SSI | ||
19 | 9 |
1 |
Yes | Yes | Yes | |||||
20 | 7 |
0 |
Yes | |||||||
21 | 14 |
2 |
Yes | |||||||
22 | 8 |
0 |
Yes | |||||||
23 | 13 |
1 |
Yes | |||||||
24 | 7 |
0 |
Yes | |||||||
25 | 11 |
1 |
Yes | Yes | ||||||
26 | 4 |
0 |
Yes | Yes | ||||||
27 | 5 |
0 |
Yes | |||||||
28 | 9 |
0 |
Yes | Yes | Yes | |||||
29 | 9 |
1 |
Yes | Yes | ||||||
30 | 10 |
1 |
Yes | |||||||
31 | 7 |
0 |
TD+BSO+ TO |
Appendicectomy | ||||||
32 | 13 |
1 |
Yes | Yes | ||||||
33 | 6 |
0 |
Yes | |||||||
34 | 11 |
1 |
Yes | Yes | Yes | |||||
35 | 16 |
2 |
Yes | Cholecystectomy | Yes | |||||
36 | 10 |
1 |
Yes | Yes | ||||||
37 | 11 |
1 |
Yes | Yes | ||||||
38 | 9 |
1 |
Yes | Yes | ||||||
39 | 7 |
0 |
Yes | Yes | ||||||
40 | 4 |
0 |
Yes | |||||||
41 | 18 |
2 |
Yes | Yes | ||||||
42 | 11 |
1 |
Yes | Rectosigmoid-RA | ||||||
43 | 12 |
1 |
Yes | Ileal -RA | ||||||
44 | 5 |
0 |
Yes | Appendicectomy | ||||||
45 | 13 |
1 |
Yes | Rectosigmoid-RA | SSI | |||||
46 | 11 |
1 |
Yes | Yes | ||||||
47 |
14 |
1 |
Yes |
|
Yes |
|
|
|
Yes |
|
48 |
19 |
3 |
Yes |
|
|
|
Yes |
|
|
|
49 |
12 |
2 |
Yes |
Yes |
Yes |
|
|
|
|
|
50 |
3 |
0 |
Yes |
|
|
|
|
|
|
|
51 |
15 |
1 |
Yes |
Yes |
|
|
|
|
Yes |
|
Table 1: The details of PCI, CCS and cytoreductive surgeries done
Surgical procedures |
Number |
|||||||||||
Gynaecological procedures: |
51 |
|||||||||||
Pelvic peritonectomy ( bladder and pouch of Douglas) |
29 |
|||||||||||
Abdominal (para colic) peritonectomy |
11 |
|||||||||||
Diaphragm stripping/resection with or without liver surface tumor excision |
12 |
|||||||||||
Appendicectomy |
09 |
|||||||||||
Mesenteric deposit excision/fulguration |
06 |
|||||||||||
Large Bowel resection anastomosis |
03 |
|||||||||||
Small bowel resection anastomosis |
02 |
|||||||||||
Cholecystectomy with porta hepatis tumor debulking |
01 |
|||||||||||
Splenectomy |
01 |
Table 2: The types of cytoreductive procedures done
PCI= peritoneal cancer index, CCS= cytoreductive completeness score, TAH=Total abdominal hysterectomy, BSO=bilateral salpingo-opherectomy, TD= tumor debulking, TO=total omentectomy, RPLND=retroperitoneal lymphadenectomy, RA= resection anastomosis, PTE= pulmonary thromboembolism, MI= myocardial infarction, SSI= surgical site infection, POD=post-operative day
PCI range |
CCS 0 | CCS 1 | CCS 2 | CCS 3 |
19 | 14 | 13 | 18 | |
10 | 21 | 34 | 19 | |
17 | 15 | 21 | ||
05 | 15 | 21 | ||
12 | 17 | 14 | ||
06 | 18 | 16 | ||
13 | 09 | 18 | ||
07 | 13 | 12 | ||
08 | 11 | |||
07 | 09 | |||
04 | 10 | |||
05 | 13 | |||
09 | 11 | |||
07 | 10 | |||
06 | 11 | |||
07 | 09 | |||
05 | 11 | |||
04 | 12 | |||
03 | 13 | |||
11 | ||||
14 | ||||
15 | ||||
*Mean PCI | 8.1 | 12.8 | 18.6 | 18.5 |
Total cases | 19 | 22 | 08 | 02 |
Table 3: PCI and CCS distribution
PCI= peritoneal cancer index, CCS= completeness cytoreduction score.
* A spearman’s rank correlation test P-value <0.0001, r=0.69
Score | Principle | Progressiveness/Aim | Advantages | Disadvantages |
Eisenkop score [15] | Score from 0 to 15; 5 anatomical regions; ranks from 0 to 3 per region |
Ovary; prediction survival | Includes pelvic and para-aortic lymph nodes |
Less precise than the PCI |
Fagotti score [16] | Score from 0 to 14; 7 anatomical structures; 0/2 points per region |
Ovary; prediction resectability | Concise | Based on laparoscopy |
Fagotti-modified score [17] |
Score from 0 to 8; 4 anatomical structures; 0/2 points per region |
Ovary; prediction resectability | Concise | Based on laparoscopy |
Gilly classification [18] | G0-G4; information regarding location of carcinomatosis (locally, disseminated) |
Colorectal tumors | Concise | Imprecise localization of the lesions |
P-Score of the Japanese Research Society of Gastric Cancer [19] |
P0-P3; information about the location of the metastases | Gastric carcinoma | Specially for gastric carcinoma | Imprecise localization and sizing of the lesions only for gastric carcinoma |
PCI [12] | Score from 0 to 39; 13 abdominal and pelvic regions, per region LS 0-3 | Gastrointestinal tumors; management standardized | Very precise description of the peritoneal carcinomatosis, can be universally used |
Lymph nodes not included |
Simplified PCI [20] | Score from 0 to 21; 7 abdominal and pelvic regions, per region LS 0-3 |
Colorectal and appendix tumors; staging |
Concise | Less precise than the PCI |
Table 4: Overview of peritoneal carcinomatosis scores
Figure 1: Sugarbaker’s PCI chart
Figure 2: A= enbloc pelvic peritonectomy specimen with uterus and ovaries, B= Enbloc resection of uterus with ovarian tumor and recto-sigmoid in an ovarian cancer infiltrating recto-sigmoid mesentery, C= enbloc pelvic and abdominal peritonectomy, D= perihepatic deposit excision with diaphragm peritonectomy, E= diaphragm peritoneum stripped with tumor deposits, F= diaphragm central tendon excision with a deposit
Figure 3: A= omental cake and splenectomy enbloc excision, B= foramen of Winslow and porta hepatis, C= porta hepatis deposit excision following cholecystectomy, D= Recto-sigmoid resection anastomosis, E= Small Bowel resection anastomosis, F= multiple bowel mesenteric tumor deposits
Tables at a glance
Figures at a glance