Purpose Achieving complete cytoreduction (CCR) is crucial for a patient’s prognosis with advanced epithelial ovarian cancer (EOC). So far, prognostic predictors have failed to predict surgical outcome after neoadjuvant chemotherapy (NACT). In clinical trials, scores were used to predict operability in recurrent ovarian cancer (Harter et al. in N Engl J Med 385(23):2123–2131, 2021) but there is no known prediction score for CCR after NACT. The Peritoneal Cancer Index (PCI) is an established tool to predict surgical outcome in primary setting (Lampe et al. in 25:135–144, 2015). We now examined the predictive power of the PCI to achieve CCR after NACT. Methods In this single-center study, the data of patients with advanced stage EOC (FIGO > IIIb) treated between 01/2015 and 12/2020 were analyzed retrospectively. Inclusion criteria were a mandatory staging laparoscopy, a PCI score > 25, and NACT. CT scans were analyzed in blinded fashion according to RECIST criteria (Borgani et al. in 237; 93–99, 2019) Reaction of PCI after NACT was compared with the analysis of radiologic imaging and CA-125 levels. Results Three hundred and sixteen patients were screened, 62 were treated with NACT, and 23 were included in our analysis. 87% of cases presented with an FIGO IIIc stadium. The reduction of PCI itself after NACT showed to be the most powerful predictor for achieving CCR. The reduction of the initial PCI score by minimum of 8.5 points was a better predictor for CCR than reaching a PCI < 25. In contrast to data deriving from patients undergoing primary debulking surgery (PDS), we found a PCI of 17, rather than 25, to be a more valuable cut-off for CCR in neoadjuvant-treated patients. Conclusion The extend of PCI reduction after NACT is a better predictor for achieving CCR compared with CA125 levels and radiologic imaging. The PCI must be assessed differently in neoadjuvant setting than in a primary situation. CCR was most likely for a post-NACT PCI < 17.

Purpose: The practice of exenterative surgery is sometimes controversial and has garnered a certain scepticism. Surgical studies are difficult to conduct due to insufficient data. The aim of this review is to present the current standing of pelvic exenteration from a surgical, gynaecological and urological point of view. Methods: This review is based upon a literature review (MEDLINE (PubMed), CENTRAL (Cochrane) and EMBASE (Elsevier)) of retrospective studies on exenterative surgery from 1993–2020. Using MeSH (Medical Subject Headings) search terms, 1572 publications were found. These were evaluated and screened with respect to their eligibility using algorithms and well-defined inclusion and exclusion criteria. Therefore, the guidelines for systematic reviews (PRISMA) were used. Results: A complete tumour resection (R0) often represents the only curative option for advanced pelvic carcinomas and their recurrences. A recent systematic review showed significant symptom relief in 80% of palliative patients after pelvic exenteration. Surgical limitations (distant metastases, involvement of the pelvic wall, etc.) are diminished by adequate surgical expertise and close interdisciplinary cooperation. While the mortality rate is low (2–5%), the still relatively high morbidity rate (32–84%) can be minimized by optimizing the perioperative setting. Following exenterations, roughly 79–82% of patients report satisfying results according to PROs (patient-reported outcomes). Conclusion: Due to multimodality treatment strategies combined with extended surgical expertise and patients’ preferences, pelvic exenteration can be offered nowadays with low mortality and acceptable postoperative quality of life. The possibilities of surgical treatment are often underestimated. A multi-centre database (PelvEx Collaborative) was established to collect data and experiences to optimize the research in this field.

Background/Aim: This study investigated the cardiophrenic lymph node (CPLN) status before and after neoadjuvant chemotherapy (NACT), as its presence seems to have a rather prognostic significance in patients with advanced ovarian cancer. Patients and Methods: The baseline computed tomography scans of 66 patients with advanced ovarian cancer primary treated with NACT between March 2015 and June 2020 were reviewed. A CPLN enlargement was defined as ≥5 mm. Results: 44% (n=29) of the patients had enlarged CPLNs; 10.7% (n=3) showed a complete response, 71.4% (n=20) a partial response, and 17.9% (n=5) a stable disease after NACT. There was no significant difference between the response to NACT measured according to the status of CPLN compared to other biomarkers in the CPLN group. Conclusion: Patients with CPLN enlargement have a tendency to an impaired prognosis. The response of CPLN to NACT was comparable to the response of established biomarkers, adding a monitoring function to the CPLN.

Introduction/Background* Advanced epithelial ovarian cancer (EOC) is a severe disease with high mortality rate. Achieving complete cytoreduction (R=0; CCR) is crucial for the patient's prognosis. Extensive peritoneal carcinomatosis is often the limiting factor for achieving CCR in EOC and therefore is the deciding factor for therapy planning. The Peritoneal Cancer Index (PCI) after Sugarbaker has been an established tool to describe the extension of the disease. A patient presenting a PCI < 25 is considered to be operable 1 . We examined the predictive power of various markers (CA-125, CTscans, PCI) for achieving complete cytoreduction after neoadjuvant chemotherapy (NACT). Methodology The data of 23 patients treated in our hospital between 01/2015 und 12/2020 with inoperable EOC were retrospectively analyzed. Clinical and radiological data were collected and statistically analysed (univariate analysis: Chi-Square Tests, Mann-Whitney U test and multivariate analysis: Binary logistic regression, ROC-curve). Result(s)* The reduction of the PCI itself after neoadjuvant chemotherapy showed to be a powerful predictor for complete cytoreduction (CCR), but it also showed to be significant even if the different PCI baseline values were considered. The reduction of the initial PCI score by minimum 8.5 points was a better predictor for CCR than the PCI < 25.Neither the RECIST analysis 2 of the CT-scans nor the reduction of the tumor marker CA-125 proved to be a significant predictor. Conclusion* Whether CCR can be achieved during debulking surgery, is best predicted by the reduction of the PCI. A combination of the three markers might be even more powerful. Larger studies are needed to confirm this.

Paraneoplastic cerebellar degeneration (PCD) is a rare n eurological disorder in cancer patients, characterized by a widespread loss of Purkinje cells associated with a progressive pancerebellar dysfunction. Furthermore, PCD is characterized by acute or subacute onset of neurological symptoms such as cerebellar ataxia, dysarthria and nystagmus due to tumor-induced autoimmunity against cerebellar antigens. It is believed that anti-Yo occurs usually in women and is most likely associated with gynecologic or breast cancers. PCD often precedes the cancer diagnosis by months to years. Here, we present a case involving a 52-year-old woman who developed PCD symptoms two months before the diagnosis of ovarian cancer, which was associated with high levels of anti-Yo antibodies