Looking Beyond the Numbers in Cancer Surgery Decisions
- 2 days ago
- 2 min read
Mouawad C, Osseis M, Pocard M. Beyond total PCI thresholds: Limitations of the surgical peritoneal cancer index in decision-making for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. The American Journal of Surgery, 2026; 257
Rethinking how doctors decide who can get major cancer surgery
This study looked at how doctors decide whether a patient with cancer that has spread inside the abdomen should have a complex surgery called CRS-HIPEC (a combination of tumor-removal surgery and heated chemotherapy).
What is CRS-HIPEC?
CRS (cytoreductive surgery): removes visible tumors in the abdomen
HIPEC: delivers heated chemotherapy directly into the abdomen during surgery
This treatment can help some patients live longer—but it is a major, high-risk procedure, so doctors must carefully decide who is likely to benefit.
What tool do doctors currently use?
Doctors often use something called the Peritoneal Cancer Index (PCI):
It’s a score from 0 to 39
It measures how much cancer has spread inside the abdomen
Lower scores = less cancer spread
Higher scores = more extensive disease
Many hospitals use a cutoff number (for example, PCI above a certain level) to decide whether surgery is offered.
What did this study find?
1. One number may be too simple
The study found that relying on a single total PCI score to decide who gets surgery has important limitations.
2. Not all cancer spread is the same
Even if two patients have the same PCI score:
Their cancer may be located in different areas
Tumors may behave differently biologically
This means the same score doesn’t always predict the same outcome.
3. Some patients may be wrongly excluded
Using strict PCI cutoffs could:
Deny surgery to patients who might benefit
Or include patients who may not benefit as much
4. Doctors should look at the “whole picture”
The study suggests treatment decisions should consider more than just one score, including:
Where the cancer is located
Tumor biology (how aggressive it is)
The patient’s overall health
What does this mean for patients?
Good news:
Decisions about surgery may become more personalized
Some patients who were previously not eligible might still be considered
Important to know:
CRS-HIPEC is still a complex and serious procedure
Not everyone will benefit, even with a more flexible approach
Why this matters
This research highlights a shift toward more individualized cancer care—moving away from “one-size-fits-all” rules and toward decisions based on each patient’s unique situation.
Bottom line
Doctors often use a scoring system (PCI) to decide who should get major cancer surgery, but this study shows that one number alone may not tell the full story. Future decisions may rely on a broader, more personalized approach to help patients get the care that’s right for them.
