Pedro Antonio Cascales-Campos

Objective: This study aims to compare the efficacy of neoadjuvant chemotherapy (NACT) followed by secondary cytoreductive surgery (SCS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) versus SCS with HIPEC alone in patients with platinum-sensitive recurrent ovarian cancer. Methods: A retrospective analysis was conducted on patients treated at Hospital Clínico Universitario Virgen de la Arrixaca from January 2011 to December 2024. Two cohorts were analyzed: those receiving NACT prior to SCS and HIPEC, and those undergoing SCS with HIPEC without prior NACT. The primary endpoint was progression-free survival (PFS), while secondary endpoints included overall survival (OS), peritoneal progression-free survival, extraperitoneal progression-free survival, and safety. Results: A total of 86 patients were included in the study, with 39 in the NACT group and 47 in the non-NACT group. The non-NACT cohort exhibited a significantly longer PFS of 20 months compared to 12 months in the NACT group (p = 0.004). Median OS was also superior in the non-NACT group, at 88 months versus 34 months (p = 0.023). Patients in the NACT group experienced longer surgical durations, increased transfusion requirements, and a higher incidence of severe complications. Conclusions: The addition of NACT prior to SCS and HIPEC does not enhance survival outcomes for patients with platinum-sensitive recurrent ovarian cancer. In fact, those who underwent SCS with HIPEC alone demonstrated better PFS and OS, underscoring the importance of careful patient selection in optimizing treatment strategies.

Introduction The indicators of surgical outcomes are handy tools in health management. Futility is a very interesting indicator, because it defines those patients who have undergone a surgical procedure with its morbidity and mortality and who have not benefited from the treatment. Knowledge of the factors that influence futility can help us better select patients with carcinomatosis of ovarian origin. Methods Multicenter study was performed. Inclusion criteria: > 18 years old, with ovarian cancer and peritoneal carcinomatosis, who underwent scheduled surgery after response to neoadjuvant therapy. The definition of Futility in ovarian peritoneal carcinomatosis was: all patients with non-CC-0, death in the first 90 days in the postoperative period or within the first year after surgery were considered futile patients. Results We included 365 patients. 84 patients (23.6%) were in the futility group compared with 279 (73.4%) who were not in the futility group. We obtained that non-obtaining CC-0 was the main factor of futility (61.6%). The 2º crucial factor of futility was mortality in the first year after surgery. The incidence of futility in the series is 23.6%. Comparing futility and non-futility groups, we could observe statistically significant differences in hospital stay, higher levels of CA125 (52 vs. 35), and higher postoperative PCI. Patients in the futility group had almost twice PCIs as those who were not. When performing univariate regression, we could observe that PCI and the PCI distributed by categories (< 10; 11–20; > 20) were independent variables associated with futility. Conclusion PCI is a relevant factor in futility in ovarian cancer.

Liver transplantation is commonly used for end-stage liver disease, but the demand for organs exceeds the supply, leading to the use of expanded criteria donors (ECDs). Organs from ECDs, especially from donors after circulatory death (DCD), encounter challenges like increased ischemia damage. Biomarkers, especially oxidative stress markers, may provide valuable insights for understanding and monitoring post-transplant events. Here, we highlight the unique value of organ preservation solution (OPS) as a non-invasive and early source of redox biomarkers, directly reflecting graft status during critical cold storage. This study investigated oxidative stress in 74 donated livers using OPS samples collected after cold storage, and also liver biopsies obtained before and after storage. We measured lipid peroxidation, protein carbonylation, DNA oxidation, and total antioxidant capacity from OPS, and performed gene expression analysis of liver biopsies. Oxidative stress markers differed based on donation type, with higher lipid peroxidation in DCD samples compared with donation after brain death (18.51 ± 2.77 vs. 11.03 ± 1.31 nmoles malondialdehyde (MDA)/mg protein; p = 0.049). Likewise, oxidative damage markers were associated with clinical outcomes: lipid peroxidation was increased in patients who developed biliary complications (21.86 ± 5.91 vs. 11.97 ± 1.12 nmol MDA/mg protein; p = 0.05), and protein carbonylation was elevated in those experiencing acute rejection (199.6 ± 22.02 vs. 141.6 ± 15.94 nmol carbonyl/mg protein; p = 0.005). Moreover, higher protein carbonylation levels showed a trend toward reduced survival (p = 0.091). Transcriptomic analysis revealed overexpression of genes associated with reactive oxygen species production in DCD livers. A predictive model for acute rejection integrating OPS biomarkers with clinical variables achieved 83% accuracy. Hence, this study underscores the importance of assessing oxidative stress status in preservation fluid as a biomarker for evaluating liver transplant outcomes and highlights the need for validation in larger, independent cohorts.

Backgroud: Ovarian cancer is the deadliest gynecologic malignancy, with most patients presenting with peritoneal dissemination at diagnosis. Complete cytoreduction and sensitivity to platinum-based systemic chemotherapy remain the most significant prognostic factors. However, even after optimal first-line management, over half of patients relapse due to residual microscopic disease. Intraperitoneal chemotherapy aims to target this component, with normothermic intraperitoneal chemotherapy long-term (NIPEC-LT) and hyperthermic intraperitoneal chemotherapy (HIPEC) being the most studied approaches. While NIPEC-LT has demonstrated improved survival in select trials, concerns regarding toxicity and catheter-related complications have limited its adoption as standard care. Conversely, HIPEC has shown survival benefits, particularly in patients undergoing interval cytoreductive surgery (iCRS) after neoadjuvant chemotherapy, leading to its inclusion in clinical guidelines. However, HIPEC is administered as a single intraoperative treatment, limiting its prolonged effect. Objectives and Method: This study investigates the combination of HIPEC and postoperative NIPEC-LT in the BICOV-1 trial, a prospective, non-randomized phase I study evaluating the feasibility, safety, and oncologic outcomes. The primary objective is to assess the treatment completion rates and morbidity. The secondary endpoints include disease-free survival (DFS), overall survival (OS), and quality-of-life measures. Combining HIPEC and NIPEC-LT is a rational approach, as both have shown independent benefits and do not overlap in toxicity. HIPEC-induced biological changes may enhance the effectiveness of subsequent intraperitoneal chemotherapy. This trial will provide essential data for future phase II/III studies assessing the role of intensified intraperitoneal treatment in ovarian cancer management.

Introduction The aim of this paper is to study the agreement between the findings described by the surgeon during surgery (surgical Peritoneal Cancer Index or sPCI) and those obtained after the histopathological analysis (pathological Peritoneal Cancer Index or pPCI) of the resection specimens, in addition to their prognostic implications. Materials and methods A consecutive series of patients diagnosed with high-grade serous ovarian cancer with peritoneal dissemination was analyzed between January 2008 and December 2022. sPCI were correlated with the pPCI results. The study considered the surgeon as a diagnostic tool and established, in ovarian cancer, the parameters of sensitivity, specificity, predictive values, and probability coefficients. Specifically, the study focused on the subgroup of patients with false-positive results from sPCI compared to pPCI and its usefulness in assessing the prognosis of the disease. Results A total of 231 patients were included, evaluating a total of 3003 peritoneal areas. The median sPCI was 9 (range: 0–35) and 7 for pPCI. Of the 3,003 peritoneal areas evaluated, 132 areas were considered false positives for sPCI. After multivariate analysis, the location of the lesions in the supramesocolic compartment (OR 2.37, 95% CI 1.19–4.53, p = 0.014) was the only independent factor related to a false-positive sPCI result. Patients with false-positive sPCI had a better disease-free survival estimate. Conclusions The main usefulness of pPCI would be determined by its ability to correct prognostic estimates of the disease, especially in the case of false positives.

Background: This study aimed to analyze the morbidity, mortality, and survival outcomes in patients with peritoneal surface malignancies who were initially considered candidates for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) but were found to have unresectable disease, resulting in nontherapeutic exploratory laparotomy. Patients and Methods: We evaluated data from our referral center for the treatment of peritoneal surface malignancies between January 2008 and December 2022. Adverse events following nontherapeutic laparotomy were classified using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Results: Among a cohort of 486 patients with peritoneal surface malignancies initially considered candidates for CRS + HIPEC, 46 cases (9.4%) were aborted due to the disease being deemed unresectable during exploratory laparotomy. The primary reasons for unresectability included extensive disease spread, observed in 28 patients, with massive small intestine involvement detected in 13 of these cases. The median duration of surgery was 90 min (range: 60–180 min). Postoperative complications occurred in 10 patients (22%), with a mortality rate of 4.3% (2 patients). Survival was significantly lower in patients who did not receive adjuvant systemic chemotherapy with palliative intent (4 months vs. 15 months, p < 0.01). Conclusions: Exploratory laparotomy in patients with peritoneal surface malignancies considered for CRS with HIPEC carries a substantial risk of complications. Improved preoperative staging using advanced technologies such as radiomics and laparoscopy is expected to reduce the number of patients undergoing nontherapeutic laparotomy.

BACKGROUND This study aimed to analyze the morbidity, mortality, and survival outcomes in patients with peritoneal surface malignancies who were initially considered candidates for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) but were found to have unresectable disease, resulting in non-therapeutic exploratory laparotomy. PATIENTS AND METHODS We evaluated data from our referral center for the treatment of peritoneal surface malignancies between January 2008 and December 2022. Adverse events following non-therapeutic laparotomy were classified using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. RESULTS Among a cohort of 486 patients with peritoneal surface malignancies initially considered candidates for CRS + HIPEC, 46 cases (9.4%) were aborted due to the disease being deemed unresectable during exploratory laparotomy. The primary reasons for unresectability included extensive disease spread, observed in 28 patients, with massive small intestine involvement detected in 13 of these cases. The median duration of surgery was 90 minutes (range: 60–180 minutes). Postoperative complications occurred in 10 patients (22%), with a mortality rate of 4.3% (2 patients). Survival was significantly lower in patients who did not receive adjuvant systemic chemotherapy with palliative intent (4 months vs. 15 months, p < 0.01). CONCLUSION Exploratory laparotomy in patients with peritoneal surface malignancies considered for CRS with HIPEC carries a substantial risk of complications. Improved preoperative staging using advanced technologies such as radiomics and laparoscopy is expected to reduce the number of patients undergoing non-therapeutic laparotomy.

Patients who achieve the textbook outcome (TO) present an uneventful postoperative course. Obtaining TO has also been related to better survival in oncological patients. Information about TO in patients with peritoneal carcinomatosis from ovarian cancer who undergo surgery is very scarce. Our objective was investigate TO in patients with carcinomatosis of ovarian origin who underwent interval surgery with or without HIPEC (TOOC) and its impact on survival. A multicenter study was performed between 2010 and 2015. Inclusion criteria were > 18 years old, with ovarian cancer and peritoneal carcinomatosis, who underwent scheduled surgery after response to neoadjuvant therapy. The criteria to establish TOOC were no major complications, no mortality, non-prolonged stay (p75:10 days), complete cytoreduction (CC-0), and no readmission. 365 patients were included, and TOOC was achieved in 204 (55.9%) patients. CC-0 cytoreduction was obtained in 312(85.5%). 7 patients (1.9%) died. 71 (19.5%) presented major complications (≥ IIIa). The readmission rate was 9.3%, and 24.9% of the patients presented a prolonged stay. The parameter with most significant negative impact on achieving TOOC was length of stay. Multivariate analysis confirmed postsurgical PCI, age, HIPEC, and time of surgery in minutes as an independent factor of TOOC. Survival analysis showed that patients who achieved TOOC had better overall survival (41 months (24.5– 67) versus 27 months (14-48.2) (p < 0.0001). TO is an easy and valuable management tool for evaluating and comparing results obtained at different centers after surgery for peritoneal carcinomatosis of locally advanced ovarian cancer. Achieving TOOC benefits overall survival.