title: Incidence and management of pleural effusions after diaphragm peritonectomy or resection for advanced mullerian cancer.
abstract: OBJECTIVE
  Diaphragm peritonectomy or resection is an effective way to cytoreduce diaphragm disease but frequently results in sympathetic pleural effusions. Our objective was to determine the incidence and management of effusions that developed after diaphragm surgery in patients with advanced mullerian cancer.
  
  
  METHODS
  We reviewed the records of all patients with stage IIIC-IV epithelial ovarian, fallopian tube, or peritoneal cancer who had diaphragm peritonectomy or resection as part of optimal primary cytoreduction at our institution from 2000-2003. All patients had preoperative and serial postoperative chest X-rays to detect and follow pleural effusions. Factors evaluated included the presence and size of preoperative and postoperative effusions, their laterality, and subsequent need for thoracentesis and/or chest tube placement for symptomatic effusions.
  
  
  RESULTS
  Of the 215 patients who had primary cytoreduction during the study period, 59 (27%) underwent diaphragm peritonectomy or resection. In addition to standard cytoreduction, 31 (53%) of these 59 patients had diaphragm surgery alone, while 28 (47%) had diaphragm surgery in combination with other upper abdominal resections. Laterality of diaphragm surgery was as follows: right only, 43 (73%); left only, 2 (3%); and bilateral, 14 (24%). Intraoperative chest tubes were placed in 7 (12%) patients. In the remaining 12 patients with preoperative effusions, postoperative effusions on the same side as the diaphragm surgery increased in 6 patients (50%), and 3 patients (25%) required postoperative thoracentesis or chest tube. In the remaining 40 patients without preoperative effusions, ipsilateral effusions developed in 24 patients (60%), and 5 patients (13%) required postoperative chest tubes. The overall rate of new or increased ipsilateral effusions was 58%; the overall rate of postoperative thoracentesis or chest tube placement was 15%. In 75% of the patients, thoracentesis or chest tubes were placed within 5 days of surgery (median, 3 days; range, 2-24).
  
  
  CONCLUSIONS
  More than half of patients developed ipsilateral pleural effusions after diaphragm peritonectomy for cytoreduction. Most were managed conservatively without requiring a chest tube or thoracentesis. The incidence of symptomatic effusions was not high enough to recommend routine chest tube placement at the time of diaphragm peritonectomy or resection.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, MRI-1026, New York, NY 10021, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenhauer
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003964:Diaphragm / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D018200:Mixed Tumor, Mullerian / Q000556:secondary / Q000601:surgery*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009519:New York City / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D011859:Radiography