Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma

Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Lorusso, Domenica; Chiappa, Valentina; Donfrancesco, Cristina; Donato, Violante Di; Indini, Alice; Aletti, Giovanni; Raspagliesi, Francesco

doi:10.1097/igc.0000000000000597

Cited by 18 publications

(15 citation statements)

References 31 publications

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“…The two techniques (DP and DFTR) described are not comparable given that surgeons do not have a choice in which technique to perform. In our cohort, more patients underwent diaphragm stripping (82.7% vs. 17.3% for DP and DFTR, respectively), which might be explained that ovarian cancer tended to be superficially spread within the peritoneal surface [7]. Patients in the two groups were similar in terms of surgical procedures and outcomes.…”

Section: Discussionmentioning

confidence: 77%

“…In the current series, we analyzed the results of patients with stage IIIC-IV ovarian carcinoma who underwent diaphragmatic procedures for primary cytoreduction. To the best of our knowledge, the present study is one of the largest series and the first study from a Chinese academic center [7,26]. Adequate exposure of the diaphragm is the very first and critical step in not only assessing tumor resectability but also performing the procedure.…”

Section: Discussionmentioning

confidence: 90%

“…Patients with advanced ovarian cancer often develop metastatic disease in the upper abdominal region, and extensive upper abdominal procedures are advocated as part of the surgical armamentarium [5]. Of note, it is estimated that nearly 40% of patients with ovarian cancer have widespread disease in the diaphragm [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Diaphragmatic Surgery and Related Complications In Primary Cytoreduction for Advanced Ovarian, Tubal, and Peritoneal Carcinoma

Ye¹

2016

Preprint

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Background: To evaluate the procedures and complications of diaphragm peritonectomy (DP) and diaphragm full-thickness resection (DFTR) during primary cytoreduction for advanced stage epithelial ovarian cancer. Methods: All the patients with epithelial ovarian carcinoma who underwent diaphragm procedures at our institution between January 2009 and August 2015 were identified. Clinicopathological data were retrospectively collected from the patients' medical records. Postoperative morbidities were assessed according to the Memorial Sloan-Kettering Cancer Center (MSKCC) grading system. Results: A total of 150 patients were included in the study. The majority of the patients had ovarian cancer (96%), stage IIIC disease (76%) and serous histology (89.3%). DP and DFTR were performed in 124 (82.7%) and 26 (17.3%) patients, respectively. A total of 142 upper abdominal procedures in addition to the diaphragmatic surgery were performed in 77 (51.3%) patients. No macroscopic residual disease was observed in 35.3% of the patients, while 84% of the total patient cohort had residual disease ≤1 cm. The overall incidence of at least one major morbidity (MSKCC grades 3-5) was 18.0%, whereas pleural effusions (33.3%), pneumonia (15.3%) and pneumothorax (7.3%) were the most commonly reported morbidities. The rate of postoperative pleural drainage was 14.6% in total, while half the patients in the DFTR group received drainage intraoperatively (11.5%) and postoperatively (38.5%). The incidence of postoperative pleural effusion was associated with stage IV disease (hazard ratio [HR], 17.2; 95% confidence interval [CI]: 4.5-66.7; P < 0.001), DFTR (HR, 4.9; 95% CI: 1.2-19.9; P = 0.028) and a long surgery time (HR, 15.4; 95% CI: 4.3-55.5; P < 0.001). Conclusions: Execution of DP and DFTR as part of an extensive upper abdominal procedure resulted in an acceptable morbidity rate. Pleural effusion, pneumonia and pneumothorax were the most common pulmonary morbidities. The pleural drainage rate was not high enough to justify prophylactic chest tube placement for all the patients. However, patients who underwent DFTR merited special consideration for intraoperative prophylactic drainage.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 90%

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Diaphragmatic Surgery and Related Complications In Primary Cytoreduction for Advanced Ovarian, Tubal, and Peritoneal Carcinoma

Ye¹

2016

Preprint

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“…Resección de diafragma La resección de diafragma debe ser realizada si la invasión tumoral es profunda. 12,22 El músculo es seccionado usando electrocauterio o tijeras con margen de 0.5-1.0 cm de músculo normal alrededor de la lesión. La cavidad pleural debe ser explorada visual y manualmente para identificar las áreas de enfermedad.…”

Section: Peritonectomía Diafragmáticaunclassified

Aspectos anatómicos y técnicos de la cirugia de citorredución de cáncer de ovario en abdomen superior

et al. 2018

Rev. chil. obstet. ginecol.

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RESUMENEl Cáncer de Ovario Epitelial es la novena causa de cáncer en la mujer y la neoplasia ginecológica más letal en países desarrollados. La mayoría de las pacientes son diagnosticadas en etapa avanzada de la enfermedad debido a la ausencia de síntomas específicos. La cirugía y la quimioterapia cumplen un rol fundamental en el tratamiento de esta enfermedad. En pacientes con enfermedad avanzada (estadios III -IV) al momento del diagnóstico, la extirpación de todo tumor macroscópico (citorreducción óptima) ha demostrado ser el factor pronóstico más importante, demostrando un beneficio tanto en tiempo libre de enfermedad como en sobrevida global. Nuestro objetivo es describir, desde una perspectiva multidisciplinaria, los aspectos técnicos más relevantes de la citorreducción del abdomen superior para aquellas pacientes con neoplasias de origen ginecológico.PALABRAS CLAVE: Cáncer de Ovario Epitelial, Citorreducción de Abdomen Superior, Cavidad Abdominal. ABSTRACTEpithelial Ovarian cancer is the ninth most frequent cancer in women and the most lethal gynecologic malignancy in developed countries. The majority of patients are diagnosed in advanced stage of the disease due to the lack of specific symptoms. Surgery and systemic treatment play a key role in the treatment of this disease. For those patients with advanced stage at the time of diagnosis (III -IV), removal of all macroscopic disease (optimal cytoreduction) has been shown as the most important prognostic factor, demonstrating improvement not only in progression free survival but also in overall survival. Our aim is to describe, in a multidisciplinary fashion, the most relevant aspect about oncological debulking procedures in the upper abdominal cavity for women with gynecological malignancies. KEYWORDS:Epithelial Ovarian Cancer, Debulking of the Superior Abdomen, Abdominal Cavity. INTRODUCCIÓNEl cáncer de ovario epitelial (COE) es la neoplasia ginecológica más letal, y la quinta causa de muerte por cáncer en mujeres en países desarrollados. 1,2 La alta letalidad se explica porque el 60-70% de las pacientes se presentan en etapas avanzadas de la enfermedad (etapa III o IV). 3 La cirugía en el tratamiento del COE tiene por objetivo realizar un diagnóstico histológico y una

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“…Numerous studies have noted that gynecologic oncologists are expanding the surgical armamentarium for EOC, diversifying their skill sets and participating in a multidisciplinary team approach to treatment [4–6]. Several studies have also reported significant increases in survival, as well as a minimal but acceptable increase in morbidity, as a result of this shift in the surgical paradigm [7–10]. …”

Section: Introductionmentioning

confidence: 99%

Feasibility, safety and clinical outcomes of cardiophrenic lymph node resection in advanced ovarian cancer

Cowan

Tseng

Murthy

et al. 2017

Gynecologic Oncology

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Objectives: Surgical resection of enlarged cardiophrenic lymph nodes (CPLNs) in primary treatment of advanced ovarian cancer has not been widely studied. We report on a cohort of patients undergoing CPLN resection during primary cytoreductive surgery (CRS), examining its feasibility, safety, and potential impact on clinical outcomes. Methods: We identified all patients undergoing primary CRS/CPLN resection for Stages IIIB-IV high-grade epithelial ovarian cancer at our institution from 1/2001–12/2013. Clinical and pathological data were collected. Statistical tests were performed. Results: 54 patients underwent CPLN resection. All had enlarged CPLNs on preoperative imaging. Median diameter of an enlarged CPLN: 1.3cm (range 0.6–2.9). Median patient age: 59y (range 41–74). 48 (88.9%) underwent transdiaphragmatic resection; 6 (11.1%) underwent video-assisted thoracic surgery. A median of 3 nodes (range 1–23) were resected. A median of 2 nodes (range 0–22) were positive for metastasis. 51/54 (94.4%) had positive nodes. 51 (94.4%) had chest tube placement; median time to removal: 4d (range 2–12). 44 (81.4%) had peritoneal carcinomatosis. 19 (35%) experienced major postoperative complications; 4 of these (7%) were surgery-related. Median time to adjuvant chemotherapy: 40d (range 19–205). All patients were optimally cytoreduced, 30 (55.6%) without visible residual disease. Median progression-free survival: 17.2mos (95% CI 12.6–21.8); median overall survival: 70.1mos (95% CI 51.2–89.0). Conclusions: Enlarged CPLNs can be identified on preoperative imaging and may indicate metastases. Resection can identify extra-abdominal disease, confirm Stage IV disease, obtain optimal cytoreduction. In the proper setting it is feasible, safe, and does not delay chemotherapy. In select patients, it may improve survival.

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Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma

Cited by 18 publications

References 31 publications

Diaphragmatic Surgery and Related Complications In Primary Cytoreduction for Advanced Ovarian, Tubal, and Peritoneal Carcinoma

Diaphragmatic Surgery and Related Complications In Primary Cytoreduction for Advanced Ovarian, Tubal, and Peritoneal Carcinoma

Aspectos anatómicos y técnicos de la cirugia de citorredución de cáncer de ovario en abdomen superior

Feasibility, safety and clinical outcomes of cardiophrenic lymph node resection in advanced ovarian cancer

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