Introduction Peritoneal cancer index (PCI) quantifies the volume and distribution of peritoneal abdomino-pelvic tumours, aiding in disease burden estimation and guiding management strategies. We assessed the relationship of PCI scores with incomplete resection rates and postoperative complications.

Methods A retrospective cohort study of radiological PCI scores and surgical outcomes in patients undergoing interval debulking surgery (IDS) for ovarian cancer in a tertiary referral centre (2021-2024) was conducted. PCI≥20 was classed as high, and surgical complexity scores (SCS) were defined by Aletti scoring.

Results Eighty patients with stage IIIB-IVB ovarian cancer underwent IDS; complete PCI data were available for 48 patients. The median radiological PCI score was 21.5±5.2. In the low PCI group (median: 16±2.6), 65%(11/17) had low, and 35%(6/17) had intermediate SCS. In the high PCI group (median: 24±3.2), 42%(13/31) had low, 39%(12/31) intermediate, and 19%(6/31) had high SCS, respectively. Complete macroscopic debulking (R0) was achieved in 88%(15/17) and 71%(22/31) in the low and high PCI groups, respectively. In both groups, there was one open and close procedure. The average length of stay was 7±3 days in the low and 11±14 days in the high PCI groups. Only 12%(2/17) had postoperative complications Clavien-Dindo ≥grade 2 in the low PCI group compared with 42%(13/31) in the high PCI group. The blood transfusion requirement was 6%(1/17) and 32%(10/31), respectively.

Conclusion/Implications Patients undergoing IDS for advanced ovarian cancer with higher PCI scores have higher surgical complexity, lower complete resection rates and more postoperative complications with longer hospital stays.