Learning curve and pitfalls of a laparoscopic score to describe peritoneal carcinosis in advanced ovarian cancer.

OBJECTIVE: To prospectively estimate the agreement between a fellow in training in gynecologic oncology and a senior surgeon performing a laparoscopic score to describe peritoneal carcinosis diffusion in patients with advanced ovarian cancer.
DESIGN: Single-institutional non-inferiority trial.
SETTING: University hospital tertiary care center. POPULATION: Ninety consecutive patients with primary advanced ovarian cancer.
METHODS: The patients underwent staging-laparoscopy by a fellow in gynecologic oncology and a senior surgeon, sequentially and blindly. Single laparoscopic parameters (omental cake, peritoneal and diaphragmatic carcinosis, mesenteric retraction, bowel stomach infiltration, superficial liver metastasis) and a comprehensive laparoscopic score (PIV) were assessed in each procedure and registered. MAIN OUTCOME MEASURES: No differences in the score discriminating performance for predicting optimal cytoreduction were observed between fellows' and seniors' evaluations.
RESULTS: The median number of staging laparoscopies performed by each fellow was 30 (range 28-32). The median score was 6 (0-10) for the fellows and 6 (0-14) for senior surgeons (p=ns). Results were superimposable in 57 of 90 patients (63.3%). Dividing the study period into two blocks, cases 1-45 and cases 46-90, differences were equally distributed over time (16.6 vs. 20%; p=0.9). The area under the curve of the receiver operating characteristic (ROC) curves for the score of fellows and seniors was 0.86 and 0.89, respectively (p=ns).
CONCLUSIONS: The laparoscopic assessment of peritoneal cancer diffusion according to a laparoscopic score can reliably be carried out by a fellow in gynecologic oncology after 12 months' experience without significant differences from a senior surgeon's assessment.