AbstractObjective To assess the accuracy of preoperative computed tomography in identifying candidates for minimally invasive interval cytoreductive surgery following neoadjuvant chemotherapy in patients with advanced ovarian cancer. Methods This retrospective, single-center study included advanced ovarian cancer patients who received 3 to 4 cycles of platinum-based neoadjuvant chemotherapy followed by interval cytoreductive surgery between July 2021 and May 2024. Preoperative computed tomography scans were reviewed by expert radiologists to assess the extent and distribution of residual disease. Patients were deemed eligible or ineligible for minimally invasive interval cytoreductive surgery based on radiological criteria. Computed tomography findings were compared with intraoperative findings to evaluate sensitivity, specificity, predictive values, and diagnostic accuracy. Site-specific concordance was assessed using Cohen's kappa. In accordance with the journal's guidelines, we will provide our data for independent analysis by a selected team by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested. Results A total of 87 patients were included. Computed tomography scan demonstrated an overall accuracy of 71.3% (95% Confidence Interval: 61.76–80.77) in predicting feasibility of minimally invasive interval cytoreductive surgery, with a sensitivity of 71.4% (95% Confidence Interval: 52.11–90.75) and specificity of 71.2% (95% Confidence Interval: 60.29–82.14). False negative and false positive rates were 28.6% and 28.8%, respectively. Concordance between computed tomography and surgical findings was moderate (Cohen's k=0.35). The highest agreement was found for small bowel and mesenteric involvement, while diaphragmatic and perihepatic sites showed the lowest concordance. Conclusions This study shows that the radiologic selection process for minimally invasive interval cytoreductive surgery is complex. The not negligible false negative and positive rates suggest that a combined approach, including diagnostic laparoscopy or advanced imaging tools, may improve surgical planning and patient selection for minimally invasive surgery at interval cytoreductive surgery.
Conte et al. (Sun,) studied this question.