Re-cytoreduction predictive Index(RECPI)-based Immune-Ascites(IMA) scoring system for peritoneal metastatic disease: A paired-analysis of surgical and oncological outcomes.

PURPOSE: There is no reliable scoring system to carefully select the recurrent peritoneal metastatic patient for potential re-cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (re-CRS&HIPEC) to optimize patient outcomes. In this cohort, it was aimed (1) to compare the postoperative surgical and oncological outcomes of patients who underwent re-cytoreduction with primary cytoreduction, (2) to assess the prognostic value of modified Glasgow Prognostic Score (mGPS) and CRP-albumin ratio (CAR), and (3) to be able to predict patients who may be a potential candidate for safe re-cytoreductive surgery with the 'developed' novel Re-Cytoreduction Predictive Index (RECPI)-based Immune-Ascites (IMA) scoring system. METHODS: Prospectively maintained database of 718 peritoneal metastasis patients treated with CRS&HIPEC was retrospectively analyzed. re-CRS was performed in 64 (9%) patients. All standart clinico-pathological characteristics, re-operative findings, morbi-mortality results, and final oncologic outcomes were compared with the parameters in primary CRS&HIPEC. Immune scores (mGPS and CAR), and ascites were specifically selected to define RECPI. RESULTS: RECPI-based IMA scoring system significantly predicted the potential candidates for re-CRS. Immune scores of mGPS and CAR in re-CRS patients were significantly higher (p = .005 and p = .01) than non-re-CRS patients. Ascites was significantly higher in patients who would have been candidates for re-CRS (p < .001). Patients having ≥2 IMA points were detected as potential candidates for re-CRS (p < .001). Postoperative high-grade complications (p < .001) and mortality (p < .001) were significantly higher in patients who had IMA score of ≥2 before first-time CRS. CONCLUSIONS: A novel RECPI-based IMA can independently select the right candidate for re-CRS&HIPEC. IMA potentially predicted high-grade complications and postoperative mortality in both primary and re-cytoreduced peritoneal metastatic patients.