Article

Pulmonary morbidity of diaphragmatic surgery for stage III/IV ovarian cancer

Department of Gynecology-Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie Paris, Paris, France.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.86). 06/2009; 116(8):1062-8. DOI: 10.1111/j.1471-0528.2009.02214.x
Source: PubMed

ABSTRACT To determine the morbidity of diaphragmatic peritonectomy.
Prospective cohort study.
A Gynecology Department of a University Hospital.
From 2005 to 2007, thirty-seven consecutive patients underwent surgery for stage IIIC or IV ovarian cancer.
Patients were separated into a diaphragmatic surgery group (n = 18) and a control group (n = 19). Diaphragmatic surgery may consist of coagulation, stripping or muscle resection.
Postoperative course and outcome were analysed.
Patients in group 1 (diaphragmatic surgery) underwent more intestinal resection (89% versus 37%, P = 0.01) and pelvic (94% versus 63%, P = 0.02) or para-aortic lymphadenectomy (94% versus 53%, P = 0.04). Neither the mean estimated blood loss (960 ml versus 909 ml) nor the rates of intra-operative blood transfusion (11 versus 9) were significantly different between the two groups. The mean operative time was higher in group 1 (480 minutes versus 316 minutes, P < 0.05). There were thirteen postoperative complications in group 1 and eight in group 2 (P = 0.065). In group 1, the main complication was pleural effusion (seven cases): four patients required secondary pleural drainage, two required only pleural puncture and one had both procedures. There were more complete cytoreduction in group 1 than in group 2 (89% versus 63%, P = 0.068).
Diaphragm peritonectomies and resections are an effective way to cytoreduce diaphragm carcinomatosis and increase the rate of optimal debulking surgery. Such procedures frequently result in pleural effusion, but with no long-term morbidity.

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    • "This trauma would promote with fluid access to the thorax from the abdomen of chemotherapy solution during HIPEC. Chéreau et al. showed a higher incidence of pleural effusion and other pulmonary complications in a group of ovarian cancer patients submitted to peritoneal diaphragmatic resection; they reported a greater number of patients requiring pleural drainage [15]. In this report, opening the pleura was required because of the carcinomatosis infiltration of the diaphragm; systematic pleural drainage was not performed routinely in these patients. "
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    • "Other radical procedures such as extensive peritoneal resections or diaphragmatic resections were not associated to significant increase of major complications. This is in accordance with Chereau et al., who found an acceptable complication rate of diaphragmatic surgery for stage III/IV ovarian cancer surgeries [19]. In another study Dowdy et al. found an increase rate of pleural effusion requiring up to 12.5% of thoracocentesis however no other major complications were associated to diaphragmatic resection [20]. "
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    • "The diaphragmatic implants can be resected with various surgical techniques, as ABC, peritonectomy or muscle resection. As previously suggested [112], [115]. The complete understanding of the upper abdominal anatomy and of the liver mobilization maneuvers are essential to allow exploration and radical debulking of the diaphragm, and minimizing the risk of major vessels injuries (retro-hepatic caval vein, supra-hepatic veins, diaphragmatic vessels) with severe haemorrhage. "
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