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.
Highlights
Ovarian cancer remains a lethal disease for patients with advanced disease
In this study we compare the surgical morbidity of patients underwent diaphragmatic peritonectomy with that of patients underwent a full-thickness resection of the diaphragm and pleura during multivisceral cytoreduction for ovarian cancer
There was a total of 117 advanced stage ovarian cancer patients who had surgical assessment for debulking and five patients did not proceed to full debulking procedure after laparoscopic assessment due to wide-spread small bowel serosal involvement (5/117)
Summary
Ovarian cancer remains a lethal disease for patients with advanced disease. Despite medical progresses, the survival figures of ovarian cancer did not significantly improve [1]. Diaphragmatic disease and pleural involvement can potentially leave many patients with suboptimal cytoreduction despite complete clearance of the pelvis [11,12,13]. With more evidences in support of a surgical effort aimed at no residual disease, the expertise for upper abdominal and diaphragmatic surgery has become important [14]. Based on the extension of the disease, surgery of the diaphragm can be limited to a peritonectomy or require a full thickness resection of International Journal of Surgical Oncology the muscle and the pleura. In this study we compare the surgical morbidity of patients underwent diaphragmatic peritonectomy with that of patients underwent a full-thickness resection of the diaphragm and pleura during multivisceral cytoreduction for ovarian cancer
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