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.