Chronic pancreatitis (CP) often leads to malnutrition and sarcopenia, negatively impacting clinical outcomes and quality of life. Although Global Leadership Initiative on Malnutrition (GLIM) and European Working Group on Sarcopenia in Older People (EWGSOP2) criteria are widely used to assess these conditions globally, Indian data is scarce. This study evaluated the prevalence and predictors of malnutrition and sarcopenia in CP patients using these criteria and their effects on health-related quality of life (HRQoL). In this cross-sectional study, 100 adult outpatients with CP were recruited. Malnutrition and sarcopenia were assessed by above criteria and HRQoL by European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (version 3.0). Muscle mass was assessed by skeletal muscle index (SMI) at third lumbar vertebral level on computed tomography. Malnutrition was identified in 45

To evaluate perfusion, diffusion tensor, and spectroscopy correlates of peritumoural brain oedema (PTBO) in intracranial meningiomas and identify imaging parameters associated with PTBO volume using multiparametric Magnetic Resonance Imaging (MRI). In this cross-sectional study of 66 adults, PTBO presence was defined as a T2-hyperintense peritumoural volume ≥ 10 mL (n = 26) and absence as ≤ 1 mL (n = 35); intermediate volumes were excluded (n = 5). Preoperative 1.5T MRI assessed relative cerebral blood volume (rCBV), apparent diffusion coefficient (ADC), fractional anisotropy (FA), and magnetic resonance spectroscopy (MRS). Independent predictors were identified via multivariable logistic regression. Diagnostic performance (Area Under the Curve, AUC) was estimated using 5-fold cross-validation. PTBO-associated tumours demonstrated significantly larger volumes, more frequent intratumoural necrosis, higher rCBV, elevated ADC, and increased choline ratios (p < 0.001 for all). Multivariable regression identified FA, rCBV, and tumour volume as independent predictors of PTBO presence. FA demonstrated superior discrimination (cross-validated AUC = 0.96; 95

Spontaneous superior mesenteric artery (SMA) branch pseudoaneurysms are exceedingly rare and should be kept as a diagnosis in patients with trauma, pancreatitis, anticoagulant use or surgery presenting with unexplained abdominal pain, sudden drop in haemoglobin or hypovolemia. Computed Tomography Angiography (CTA) and Digital Subtraction Angiography (DSA) both readily demonstrate the vascular abnormality, with DSA being advantageous for therapeutic purposes. Computed Tomography (CT) of the abdomen frequently identifies haemoperitoneum or a localised hematoma at the site of a vascular abnormality. Embolisation with glue and coil is a safe and less invasive technique for successful endovascular repair. A male patient in the sixth decade of life presented with unexpected haemoperitoneum during laparotomy for radical cystectomy. After abandonment of the surgery, the patient underwent a CT abdomen revealing a pseudoaneurysm arising from the transverse pancreatic branch of the SMA, leading to retroperitoneal haematoma and haemoperitoneum, and subsequently underwent successful glue embolisation. Retrospectively evaluated CT abdomen done for preoperative evaluation in the recent past was normal. This case report highlights SMA branch pseudoaneurysms presenting as unexplained haemoperitoneum and retroperitoneal haematoma in an asymptomatic patient, successfully treated by the endovascular route.

Background: Upper urinary tract diseases often present with flank pain and hematuria, commonly investigated using plain radiography, IVU, ultrasound, CT, and MR urography. MDCT is the preferred imaging modality due to its high sensitivity, but it has limitations like radiation exposure and protocol variability. MR urography offers a radiation-free alternative but is limited by availability, difficulty in detecting stones, and artifacts. Efforts are ongoing to optimize MDCT protocols to reduce radiation and improve diagnostic accuracy. A cross-sectional comparative study of MDCT Urography in upper urinary tract diseases using single and triple bolus contrast media injections. Material and Methods: Ninety patients were screened over 20 months. Computerized random number tables were used to allocate patients to each protocol. Qualitative and quantitative (Hounsfield units) comparisons were performed for the upper urinary tract, renal parenchymal enhancement, and renal vessels. Results: Seventy-three patients’ data were analysed. Triple bolus reduces the radiation dose by more than 50% compared to the conventional single-bolus protocol. A single bolus is better (p<0.0001) than a triple bolus for intrarenal collecting system and ureteric opacification. Triple bolus is best for renal vein opacification (p<0.0001). Conclusion: Triple bolus is better for renal vein opacification. A single bolus is better for opacifying the collecting system. No statistically significant difference in renal parenchymal enhancement was noted between the protocols. Keywords: Split bolus, Triple bolus, Multidetector Computed tomography, Urography.

Postoperative pancreatic fistula (POPF) remains one of the most significant causes of morbidity following pancreatoduodenectomy (PD). The Alternative Fistula Risk Score (a-FRS) incorporates body mass index (BMI) as a surrogate measure of adiposity. Nevertheless, BMI frequently inadequately captures the “thin-fat” phenotype prevalent in Asian populations, wherein individuals may display significant visceral adiposity despite possessing a normal or low BMI. This study aimed to evaluate whether visceral adipose tissue (VAT) is superior to BMI in predicting clinically relevant postoperative pancreatic fistula (CR-POPF) in an Indian patient cohort. This prospective observational study included 48 patients undergoing pancreatoduodenectomy at a tertiary care center. Preoperative VAT area (cm2) was quantified at the level of the L3 vertebra using semi-automated CT analysis software (Syngo.via). The primary outcome was the development of CR-POPF as defined by the 2016 International Study Group of Pancreatic Surgery (ISGPS) criteria. The diagnostic performance of VAT and BMI was compared using receiver operating characteristic (ROC) curve analysis. The incidence of CR-POPF was 31.2

Hepatocellular carcinoma (HCC) is a clinically significant primary liver malignancy that predominantly occurs in patients with cirrhosis and chronic liver disease. Early detection and accurate, non-invasive diagnosis are critical for improving survival outcomes, guiding therapeutic decision-making, and determining eligibility for liver transplantation. Imaging plays a central role in this process and frequently allows definitive diagnosis without the need for biopsy. The Liver Imaging Reporting and Data System (LI-RADS), developed by the American College of Radiology (ACR), was created to standardize liver imaging acquisition, interpretation, categorization, and reporting in populations at risk for HCC. Since its introduction, LI-RADS has evolved to encompass ultrasound surveillance, contrast-enhanced ultrasound, multiphase computed tomography, magnetic resonance imaging, and treatment response assessment algorithms, including nonradiation and radiation-based therapies. This narrative review provides a comprehensive overview of LI-RADS, encompassing its evolution and the latest developments in its diagnostic, surveillance, and treatment response algorithms.

Introduction Endoscopic ultrasound-guided liver biopsy (EUS-LB) is an emerging alternative to percutaneous liver biopsy (PC-LB), offering simultaneous assessment of varices and portal pressure and reduced patient discomfort. Prospective data comparing the two are limited. Methodology In this prospective cohort study at a tertiary centre, consecutive patients undergoing EUS-LB with 19G fine-needle biopsy (FNB) needle or PC-LB for parenchymal liver disease were enrolled. Exclusions: grade 2/3 ascites, INR >1.5, platelets <50,000/mm3, inability to stop anticoagulation, and pregnancy. Technique was decided after discussion with patient. Primary outcome was sample adequacy defined as aggregate sample length (ASL) ≥20 mm and ≥11 complete portal triads (CPT). Secondary outcomes: ASL, longest core (LC), CPT count and adverse events. Results Of the sixty patients included (EUS-LB n=30; PC-LB n=30), platelet counts were higher in those who underwent EUS-LB, rest of the blood parameters being similar . Deranged liver enzymes were the predominant indication (EUS-LB 63%, PC-LB 83%). Adequate samples were obtained in 100% of EUS-LB versus 57% of PC-LB cases (p<0.001). EUS-LB yielded greater ASL (5.4 ± 1.6 cm vs 4.0 ± 1.9 cm; p=0.002), LC (2.1 ± 0.8 cm vs 1.4 ± 0.6 cm; p=0.001), and more CPT [median 15 (IQR 12.5–18) vs 12 (IQR 8.2–16); p=0.01]. Immediate post-procedure pain scores were lower with EUS-LB [median 1 (0–2) vs 4 (4–6); p<0.001]. No major complications occurred; puncture-site bleed occurred in 2 (6.6%) EUS-LB patients and was controlled endoscopically. Conclusion EUS-LB is a feasible alternative to PC-LB with a comparable diagnostic yield, lesser immediate post procedure discomfort and comparable safety profile.

Pelvic desmoid fibromatosis is a rare locally aggressive benign neoplasm, typically presenting in the reproductive age group with lower abdominal pain. Extra-abdominal occurrence being predominant, the pelvic origin of the tumour makes the clinical management a multidisciplinary challenge. Previous surgeries, current or previous pregnancies, and familial adenomatous polyposis have been documented as associated risk factors. Our patient was a young woman with three previous caesarean sections, admitted with a large infiltrative lesion extending into the left pelvic sidewall up to the pelvic bone, causing ipsilateral severe hydroureteronephrosis. Malignancy was suspected due to the infiltrating nature of the lesion on imaging. Due to its proximity to the pelvic veins, preoperative embolisation of the feeding vessel was done. An exploratory laparotomy was performed by a multidisciplinary team. For this deep-seated disease, mass excision was performed along with total hysterectomy, left salpingo-oophorectomy and left ureteroneocystostomy. A part of the lesion infiltrating the presacral fascia was not removed during the primary surgery. Within 24 hours of surgery, she developed critical limb ischaemia in the left limb due to thrombosis in the ipsilateral external iliac artery. An emergency thrombo-embolectomy was performed by the vascular surgeons and thromboprophylaxis continued. Final histopathology confirmed desmoid fibromatosis. For the residual disease, the patient has been under close follow-up and is receiving targeted therapy with oral sorafenib to prevent local progression. Her follow-up imaging showed a decrease in the size of the residual disease and she is asymptomatic currently.

Background Increased intracranial pressure (ICP) can be reliably detected at the bedside using the optic nerve sheath diameter (ONSD). The functional outcome in stroke patients can be predicted with the use of acute-phase ONSD dynamics. Objectives To determine the predictive accuracy of ONSD on days 0, one, and three for the prognosis of ischemic stroke patients presented to emergency medicine as measured by Modified Rankin Scale (mRS) score. Methods The study involved the enrollment of patients who presented to the emergency department with clinical and radiological diagnosis of ischemic stroke within 24 hours of onset of symptoms. On the day of the incident, day one and day three, the optic nerve sheath diameter was measured transorbitally, 3 mm behind the optic disc. On days 28 and 90, the patient's functional outcome was evaluated using the mRS score. An mRS score of ≤ 3 is considered a good functional outcome, and > 3 is considered a poor functional outcome. Results Study participants were sixty-six people who had experienced an acute ischemic stroke. Mean age was 55.30 ± 13.99, and 56.1% of patients were male. The mean ONSD at all time points during serial monitoring differed significantly between the poor and good functional outcomes. The change in ONSD over time, i.e., from day 0 to day three, was statistically significant in poor functional outcome (Friedman Test: χ2 = 25.6, p < 0.001) for day 28, as well as day 90 (Friedman Test: χ2 = 27.3, p < 0.001). In good functional outcome patients, the change in ONSD for the above-mentioned period was not statistically significant on day 28, as well as on day 90. Cut off ONSD 0.47 cm on day 0 can predict poor functional outcome with 100% specificity and 61% sensitivity for day 28 and 73% sensitivity for day 90. Conclusion Measurement of ONSD with ultrasound had a moderate potential to predict poor functional outcome (mRS > 3) on day 90 in individuals presenting to the emergency room. The trend of ONSD on days 0 to three can assist in predicting functional prognosis in acute ischemic stroke.

Unicornuate uterus results from incomplete Müllerian duct development and often includes a rudimentary horn. Pregnancy in such a rudimentary horn is rare. The video presents the robotic management of a 21-week, ruptured rudimentary horn pregnancy, emphasizing preoperative planning and surgical excision using a robotic platform, highlighting a novel minimally invasive technique for this rare obstetric emergency. A primigravida with a unicornuate uterus presented with a ruptured rudimentary horn pregnancy at 21 weeks and 4 days of gestation. Imaging confirmed fetal expulsion into the peritoneal cavity with moderate hemoperitoneum. The patient underwent right internal iliac artery embolization to minimize blood loss, followed by robotic excision of the ruptured horn, fetus, and placenta through posterior colpotomy. The procedure was completed using a multiport robotic setup with minimal intraoperative blood loss. The surgery was completed in 45 minutes with minimal complications. The patient had an uneventful postoperative recovery. Robotic-assisted surgery provides a safe, minimally invasive alternative to laparotomy for ruptured rudimentary horn pregnancies in well-selected patients. Meticulous planning, patient selection, and a multidisciplinary approach are key to success.

A 35 year female patient presented to emergency department with abdominal distension, hematemesis and shock. She was known case of vitiligo vulgaris and chronic liver disease secondary to Autoimmune Hepatitis with features of Portal Hypertension. She had history of upper GI bleed in last 6 months and had undergone endoscopic glue and coil injection into gastric varices. On evaluation, her baseline investigations were hemoglobin 5.6 g/dl, serum creatinine of 1.1 mg/dl, serum bilirubin 2.3 mg/dl, INR 2.13 and serum albumin 1.92 g/dl. Endoscopy revealed small esophageal varices, severe portal hypertensive gastropathy and gastric varices with glue cast in situ, with no active bleed. Triple phase CT abdomen revealed shrunken/cirrhotic liver with splenomegaly and varices in region of fundus of stomach and esophagus (GOV2) with gastro-renal shunt measuring 14 mm (Fig. 1) which was draining to retro-aortic left renal vein (Fig.2). Previous coil and glue mass was also seen in gastric varices with contrast opacification of rest of the patent varices. Patient was simultaneously stabilized with vasopressors, blood transfusion and supportive care and also decision was made for retrograde transvenous obliteration of gastric varices. Both right jugular and right femoral access taken. GRS cannulated via femoral route and 7 Fr long sheath deployed (Fig. 3). C2 catheter was also negotiated into GRS. From femoral route 20 mm diameter AVP II plug deployed (~40% oversizing) and venogram done, which showed single efferent vein with insignificant collaterals (Fig 4). Varices and afferents were not opacified due to high flow. After significant stasis of contrast, sclerosant mixture of sodium tetradecyl sulphate, iodinated contrast and gel foam were injected in ratio 1:2:4 into efferent vein under fluoroscopic guidance. Sclerosant mixture was injected till complete opacification of gastric varices and minimal entry into afferent veins seen (Fig 5). C2 catheter removed and AVP II plug detached from introducer needle. Procedure was uneventful. On Postoperative day 1 NCCT abdomen was done to see the extent of sclerosant mixture deposition (Fig 6). Patient was discharged on postoperative day 2 in stable condition. At one month follow up patient was ambulatory and had persistent mild ascites. Lab investigations were hemoglobin of 9 g/dl, serum creatinine of 0.49 mg/dl, serum bilirubin-1.01 mg/dl, INR of 1.1 and serum albumin of 3.39 g/dl. Improvement in bilirubin levels, INR and albumin levels were noticed.

Background The gold standard for assessing liver fibrosis is liver biopsy, which is a painful, invasive technique. Point Shear Wave Elastography (P-SWE) imaging is an advanced and new promising ultrasound based diagnostic method that analyses the wave propagation speed and helps in the assessment of tissue stiffness. Our study is first study from North India wherein we have tried to assess the liver stiffness (P-SWE using Esaote MyLab9 Exp Ultrasound) in patients with alcohol associated acute pancreatitis (AA-AP), and therein tried to evaluate the diagnostic performance of P-SWE against biochemical index (APRI index). Objective The objective of this study was to assess the effectiveness of P-SWE as a diagnostic tool, in comparison to biochemical indices in patients with AA-AP. Material and Method 73 patients with alcohol related acute pancreatitis (cases) and 67 patients with non-alcohol related acute pancreatitis (controls) was recruited in this study. P-SWE was done in all 140 patients and utilized for grading of liver fibrosis. Observation and Result Mean P-SWE measurement in cases was 1.68 ± 0.17 m/s, and controls was 1.30 ± 0.14 m/s. Cut off value of 1.4 m/s had sensitivity of 93.2%, specificity of 88.1%, positive predictive value of 89.5%, negative predictive value of 92.2%, diagnostic accuracy of 90.7% and area under ROC curve = 0.911. There was positive correlation between amount of alcohol intake (g/day) and P-SWE (m/s). P-SWE positively correlated [Pearson correlation (r): +0.76] with APRI results in our study. Conclusion P-SWE can provide valuable information about liver stiffness in patients with AA-AP and help to predict the stage of liver fibrosis. Ultimately, early diagnosis plays a crucial role in patient management, since there is high chance of regression or reversal of liver fibrosis in early stage. The available cut off values of P-SWE was also validated in this study with high diagnostic performance for significant fibrosis (F2), severe/advanced fibrosis (F3) and cirrhosis (F4).

Obesity is a well-known risk factor for cardiovascular disease. Measurement of pericardial fat (PF) by multidetector computed tomography (MDCT) might have potential for early diagnosis and assessment of risk of coronary artery disease (CAD). Our study is the first study from India, wherein we have tried to find the association of PF with the severity of CAD. To evaluate the association of PF quantified by MDCT with the severity of CAD. This cross-sectional study was performed at a single-tertiary-care center over a period of 18 months, and included patients who referred for coronary computed tomography: (1) suspected case of CAD, (2) symptomatic patient with intermediate pretest probability of CAD, or uninterpretable electrocardiogram, or unable to exercise on stress test. Periprostatic fat volume (PFV) was quantified using semiautomated technique, for measuring the amount of fat during end-systolic phase. Patients who had evidence of CAD were considered “CAD positive” in this study. A total of 87 patients were enrolled in this study. However, 7 patients were excluded due to motion artifacts and 80 patients (females, 27.5%, and males, 72.5%; mean age, 49.30 ± 12.27 years) were eligible for this study. PFV ranged from 28 to 547 mL, and the median value of PFV was around 100 mL. Our study demonstrated a significant association between PF and age/body mass index/risk factors such as diabetes or family history. Higher PF was strongly associated with calcium score and severity of stenosis on computed tomography coronary angiography. Thus, PF is a risk predictor in subclinical CAD patients.

Gallbladder cancer (GBC) is the most common malignancy of the biliary system, often associated with a poor prognosis in its advanced stages. The GB-RADS (Gallbladder Reporting and Data System) was recently developed to standardize the interpretation of ultrasound findings and evaluate the risk of malignancy. This study aims to assess the role of GB-RADS in predicting malignancy in cases of gallbladder wall thickening. All patients aged 18 years and above with gallbladder wall thickening > 3 mm in screening USG were included between August 2022 to March 2024. GB-RADS score was then compared to histopathological diagnosis of surgical specimen for resectable disease and FNAC/core needle biopsy for unresectable disease. A total of 150 patients were assessed in this study, all of whom underwent evaluation of GB-RADS via ultrasonography. Among them, 14 (9.2

Cytotoxic lesions of the corpus callosum (CLOCC) describe secondary reversible entities, infections being the forerunner aetiology, with metabolic forming another subset. Coronavirus disease-2019 (COVID-19) infection highlighted CLOCC due to its frequent occurrence in infected and post-vaccinated individuals. Cytokine-mediated response, with contribution from other pathways, affected particularly vulnerable splenium of the corpus callosum. Clinical presentation was typical of neurological affliction, including visual and auditory pathway involvement. Scattered cases of atypical neurological and other system involvement were seen. Magnetic resonance imaging (MRI) showed characteristic imaging findings, associated white matter and other changes. Complete recovery was the norm, with few exceptions. This study aimed to review pathogenesis, neurological and imaging manifestations of CLOCC concerning various aetiologies and differentials, the forerunner being COVID-19, and highlight a few instances of atypical presentation. Authors searched the PubMed database for articles published in the Last 5 Years using the keywords ‘Cytotoxic lesions of corpus callosum COVID-19 MRI’. Articles explaining pathogenesis, clinical symptomatology and imaging findings were included, with few articles depicting atypical neurological and imaging findings. Well-defined altered signal intensity lesion in the corpus callosum, showing diffusion restriction, confined to splenium in the majority. Involvement of the rest of the corpus callosum adjoining cerebral white matter is seen in a few cases with enhancement and haemorrhage. Neurological symptoms were dominant, with adjunct abdominal manifestations in a few. Complete clinical and imaging resolution was the norm in the vast majority.

The Ovarian-Adnexal Reporting and Data System magnetic resonance imaging (O-RADS MRI) is a standardized risk stratification system designed to enhance uniform interpretation and reporting of adnexal masses on MRI. A PubMed search was conducted using the keyword "O-RADS MRI," yielding 61 articles in the search results. After excluding eight articles, 53 articles were selected. Additionally, five articles were identified through a citation search. A total of 58 articles were included in this literature review. Ultrasonography (USG) is the primary imaging modality used for evaluating adnexal lesions, with MRI reserved for cases that require further evaluation. Based on both USG and MRI imaging, various scores are assigned to a particular lesion. Contrast imaging, utilizing both ultrasound USG and MRI, is employed for the better characterization of lesions in terms of internal morphology, with a primary focus on solid components. Additionally, internal septation, wall characteristics, and other soft tissue components, including fat, fibrous tissue, and blood products, are also evaluated. Advanced MRI techniques, such as diffusion-weighted imaging and dynamic contrast-enhanced sequences, also help refine the final O-RADS score of a lesion. Contrast-Enhanced Computed Tomography (CECT) plays a predominant role in evaluating metastatic disease and has been established in five cases. This review article provides a comprehensive overview of O-RADS MRI, addressing its development, key imaging features, and practical application in a clinical setup. We discuss the diagnostic performance of O-RADS MRI in differentiating benign from malignant adnexal lesions, exploring its strengths in reducing inter-observer variability and guiding patient management. We also highlighted various comparative studies and trials that have shaped the evolution of the O-RADS MRI system over time. Furthermore, this article highlights the challenges associated with implementing O-RADS MRI, including potential pitfalls in interpretation, corroborations, and discordance with other imaging modalities, particularly USG, as well as the need for further validation studies.

BACKGROUND Sepsis is a critical medical condition, and poses a substantial global health burden, with significant morbidity, mortality, and economic costs, particularly pronounced in low- and middle-income countries. Effective management of sepsis relies on early recognition and appropriate intervention, underscoring the importance of accurate classification to guide treatment decisions. The correct diagnosis will lead to effective antimicrobial stewardship practices. AIM To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications. METHODS This longitudinal observational study in the Department of General Medicine, in a tertiary care hospital in Northern India, from 2023 to 2024, aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system. The study also aimed to correlate antibiotic usage. Patients were categorized into sepsis classes (Asepsis, Possible Sepsis, Probable Sepsis, Confirmed Sepsis) and followed until discharge or Day-28. Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system. RESULTS A total of 1867 patients admitted with suspected sepsis were screened, with 230 meeting the inclusion criteria. Among the study cohort (mean age 40.70 ± 14.49 years, 50.9% female), initial sepsis classification predominantly included probable sepsis (51.3%) and possible sepsis (35.7%), evolving to asepsis (57.8%) upon final classification, but all received antibiotics. Empirical antibiotic use showed a predominance of Watch group antibiotics (72.2%), with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed; however, no statistical association could be established among the different classes of sepsis with the AWaRe groups. CONCLUSION Accurate sepsis classification is pivotal for clinical decision-making, optimizing antibiotic use, and combating antimicrobial resistance. The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization. The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation, potentially reducing unnecessary antibiotic exposure. Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.

5547 Background: Triaging women with advanced epithelial ovarian cancer (AEOC) into primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) remains largely subjective. Methods: This prospective observational study recruited women over 18 years with stage III-IV AEOC. Decision for PDS or NACT was based on patient-specific factors and radiological parameters. The agreement between clinical decisions and predictive models—Aletti’s surgical complexity score, MSKCC Team Ovary criteria, Mayo triage algorithm, and Integrated Predictive Model (IPM) was assessed using kappa statistics. Results: 72 women with AEOC were included, with 17 (23.6%) assigned to the PDS and 55 (76.4%) to NACT. Amongst NACT patients, interval debulking surgery (IDS) was feasible in 30 women (54.5%), while 25 (45.5%) did not undergo surgery due to reasons such as disease progression, death, poor performance status, stable disease, or loss to follow-up. No difference was observed between the NACT and PDS groups in demographic parameters. Performance scores differed significantly, with higher scores observed in the NACT group compared to the PDS group: median ECOG (2 [1–2] vs. 1 [1–1], p < 0.001), ASA score (2 [2–3] vs. 2 [2–2], p = 0.005), and frailty index (0.26 ± 0.11 vs. 0.15 ± 0.05, p < 0.001). Serum albumin levels were lower (3.0 ± 0.51 vs. 3.7 ± 0.30 g/dL, p < 0.001), and median CA125 levels were higher (1170 [341–2637] vs. 494 [219.7–1000] U/mL, p < 0.001) in the NACT group. Radiological parameters, including median peritoneal carcinomatosis index (PCI) scores (16 [10–23] vs. 5 [3–8], p < 0.001), volume of ascites, pleural effusion, and disease at challenging operative sites, were also higher in the NACT group (p < 0.05). Surgical outcomes, including surgical PCI scores (5[2-6] vs 6[3-11], =0.35), residual disease rates (complete/optimal debulking: 96.6% vs. 88.2%, p = 0.42), surgical complexity score (4.7 ± 1.45 vs. 4.4 ± 1.33, p = 0.82), blood transfusion rates (80% vs. 70.6%, p = 0.76), and grade 2-3 complications (60% vs. 58.8%, p = 0.58) were similar in both groups. Baseline predictive scores were significantly higher in the NACT group compared to the PDS group: Aletti’s surgical complexity score (8.4 ± 2.80 vs. 5.2 ± 1.25, p < 0.001), MSKCC Team Ovary criteria (6.4 ± 3.31 vs. 1.9 ± 1.49, p < 0.001), Mayo triage algorithm (0.87 ± 0.39 vs. 0.24 ± 0.44, p < 0.001), and IPM final score (high-risk: 69.1% vs. 52.8%, p < 0.001). Clinical decisions showed moderate concordance with the Mayo triage algorithm (κ = 0.57) and IPM score (κ = 0.51) and fair concordance with Aletti’s score (κ = 0.33) and MSKCC criteria (κ = 0.23). Conclusions: Triage decisions based on patient performance status, nutritional factors, and disease extent demonstrated moderate concordance with predictive models. Both PDS and IDS had excellent cytoreductive outcomes with similar perioperative performance aligning with results from literature.