Re-cytoreduction predictive Index(RECPI)-based Immune-Ascites(IMA) scoring system for peritoneal metastatic disease: A paired-analysis of surgical and oncological outcomes
In brief
Two-point IMA score selects repeat cytoreduction candidates and predicts higher complications
In a series of 718 peritoneal metastasis cases, an IMA score of 2 or more accurately identified the 64 patients (9%) who could undergo repeat cytoreductive surgery with HIPEC, while also flagging a markedly higher rate of severe postoperative complications and mortality. The tool may help surgeons balance potential benefit against risk, but needs validation in larger cohorts.
- Journal
- European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Q1)
- Published
- 13 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Berke Manoğlu, Selman Sökmen, Tayfun Bişgin, Ayşe Coşkun Beyan, Beste Yıldırım, Hülya Ellidokuz
- PMID
- 42721945
- DOI
- 10.1016/j.ejso.2026.112058
Why clinicians should know about it
- Picked for Surgery (paper of the day, 15 September 2026): RECPI‑IMA scoring predicts re‑CRS suitability and complications
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.