Pulmonary morbidity of diaphragmatic surgery for stage III/IV ovarian cancer.
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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ABSTRACT: The present study assessed the use of an intraoperative tube thoracostomy for patients with primary advanced-stage ovarian, fallopian tube, or peritoneal cancer who underwent a diaphragmatic resection as part of debulking surgery and to define which patients are more likely to benefit from an intraoperative tube thoracostomy. All consecutive patients with stage IIIC-IV Müllerian cancer who underwent diaphragmatic resection at our institution between April 2008 and March 2013 were retrospectively reviewed. When a full-thickness resection of the diaphragm was performed and the thoracic cavity was opened, a chest tube was routinely placed during surgery. Patient-, disease-, and surgery-related data were collected from the patients' medical records. The data were evaluated with particular attention directed at pleural effusion after diaphragmatic resection. A total of 37 patients were included in this study. No complications associated with the intraoperative tube thoracostomy procedures occurred. An infection of the thoracic cavity occurred in one patient, following the presence of intra-abdominal abscess. The total volume of pleural drainage ranged from 88 to 2826mL (median, 965mL). The estimated blood loss, intraoperative blood transfusion, and area of the diaphragmatic opening were significantly associated with the total volume of pleural drainage in univariate analyses. In a multivariate analysis, the estimated blood loss was the only factor to be significantly associated with the total volume of pleural drainage. A prophylactic tube thoracostomy might be considered if the volume of the estimated blood loss is higher than usual.Gynecologic Oncology 07/2013; · 3.93 Impact Factor
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ABSTRACT: Objectives. Compare the surgical morbidity of diaphragmatic peritonectomy versus full thickness diaphragmatic resection with pleurectomy at radical debulking. Design. Prospective cohort study at the Oxford University Hospital. Methods. All debulking with diaphragmatic peritonectomy and/or full thickness resection with pleurectomy in the period from April 2009 to March 2012 were part of the study. Analysis is focused on the intra- and postoperative morbidity. Results. 42 patients were eligible for the study, 21 underwent diaphragmatic peritonectomy (DP, group 1) and 21 diaphragmatic full thickness resection (DR, group 2). Forty patients out of 42 (93%) had complete tumour resection with no residual disease. Histology confirmed the presence of cancer in diaphragmatic peritoneum of 19 patients out of 21 in group 1 and all 21 patients of group 2. Overall complications rate was 19% in group 1 versus 33% in group 2. Pleural effusion rate was 9.5% versus 14.5% and pneumothorax rate was 14.5% only in group 2. Two patients in each group required postoperative chest drains (9.5%). Conclusions. Diaphragmatic surgery is an effective methods to treat carcinomatosis of the diaphragm. Patients in the pleurectomy group experienced pneumothorax and a higher rate of pleural effusion, but none had long-term morbidity or additional surgical interventions.International journal of surgical oncology. 01/2013; 2013:876150.
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ABSTRACT: PURPOSE: Surgical cytoreduction remains a cornerstone in the management of patients with advanced and recurrent epithelial ovarian cancer (EOC). Diaphragm involvement is a common site of metastases and represents a major limit in the achievement of an optimal cytoreduction. The purpose of this manuscript is to discuss the rationale of diaphragmatic surgery and the morbidity related to this procedure in advanced and recurrent EOC. METHODS: A search of the National Library of Medicine's MEDLINE/PubMed database until August 2012 was performed using the keywords: 'diaphragmatic surgery' and 'ovarian cancer'. RESULTS: Surgical treatment of diaphragmatic disease in advanced stage and recurrent EOC patients leads to high rates of optimal cytoreduction. It also correlates with an improved survival in advanced-stage EOC. The most common post-operative complication is a pleural effusion with rates ranging from 10 to 60 %. Pleural effusions are more common after diaphragmatic resections as compared to diaphragmatic stripping or coagulation. The need for post-operative thoracentesis or chest tube placement is low. The routine use of intraoperative trans-diaphragmatic decompression of pneumothorax reduces these rates. Diaphragmatic lesions at the time of interval debulking are less frequent and smaller in size. The morbidity of diaphragmatic surgery in this setting is lower as compared to a primary debulking; this is probably related to the fewer multivisceral radical procedures performed. CONCLUSIONS: Diaphragmatic surgery at the time of cytoreduction increases rates of optimal cytoreduction and improves survival in advanced-stage and recurrent EOC patients. Gynecologic oncologists should be confident with its indication, technique and morbidity.Archives of Gynecology 01/2013; · 0.91 Impact Factor