Minimally Invasive Surgery for Resection of Diaphragm Metastases in Ovarian Cancer

Abstract

Study ObjectiveTo estimate pulmonary complications and diaphragm recurrence after resection of diaphragm metastases by minimally invasive surgery (MIS) for epithelial ovarian cancer (EOC). DesignRetrospective analysis (Canadian Task Force classification III). SettingMayo Clinic in Scottsdale, Arizona, from January 1, 2004, through January 31, 2014. PatientsSelected cohort of 29 patients. InterventionsDiaphragm resection by MIS (robotics, 21; laparoscopy, 8) for EOC. Measurements and Main ResultsTo assess for pulmonary complications most likely due to diaphragm resection, patients were excluded if they had preoperative pleural effusions or pulmonary disease or had undergone additional upper abdominal procedures. Mean patient age was 58.7 years (standard deviation, 14.9) and mean BMI was 24.2 kg/m2 (standard deviation, 3.4). The mean size of diaphragm metastases was 56.7 mm (range, 2–145). Full-thickness resection was performed in 6 patients; 23 had peritoneal resection. Complete resection was achieved in all patients with no conversions to laparotomy. Two patients (6.9%) had pulmonary complications (pleural effusion). Six patients (20.7%) had diaphragm recurrence; 10 patients (34.5%) had recurrence at other abdominal sites. ConclusionResection of diaphragm metastases by MIS appears to be feasible and safe for selected patients, with similar recurrence as other abdominal sites.