title: Upper abdominal surgery in advanced and recurrent ovarian cancer: role of diaphragmatic surgery.
abstract: OBJECTIVE
  Upper abdominal spread of primary and recurrent ovarian cancer is often considered to be a major obstacle to achieve optimal residual disease at the end of surgery. In this study, we investigate the role of diaphragmatic debulking in the natural history of advanced and recurrent epithelial ovarian cancer patients, and the morbidity of this procedure according to clinico-surgical characteristics.
  
  
  METHODS
  Data from 234 consecutive patients with primary and recurrent advanced ovarian cancer, operated at Catholic University of Rome and Campobasso from January 1, 2005 and December 31, 2008, were retrospectively reviewed.
  
  
  RESULTS
  Eighty-seven patients (37.2%) underwent a diaphragmatic surgery. Median age was 55 years (range 37-76). Diaphragmatic debulking was performed in 50 out of 120 patients at primary surgery (41.7%), in 16 out of 74 at interval debulking surgery (21.6%) and in 21 out of 40 secondary cytoreductions (52.5%). In the whole study population optimal residual disease at the end of surgery was achieved. The most frequent post-operative complication was pleural effusion, observed in 37 patients (42.5%). Presence of a post-operative pleural effusion was correlated liver mobilization (52.3% vs. 16%; p<0.0027) and large diaphragmatic disease (>5 cm) removal (54.1% vs. 23.5%; p<0.034).
  
  
  CONCLUSIONS
  Diaphragmatic surgery represents a crucial step in the debulking of advanced and recurrent ovarian cancer patients. Considering the natural history of advanced epithelial ovarian cancer and the rate of patients needing diaphragmatic debulking during primary cytoreduction, interval debulking surgery and secondary cytoreduction, this procedure should be present in the surgical repertoire of a gynecologic oncologist.
authors.affiliation: Department of Obstetrics and Gynecology, Division on Gynecologic Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy. francesco.fanfani@rm.unicatt.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
authors.forename: Valerio
authors.initials: V
authors.lastname: Gallotta
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ercoli
authors.forename: Fabio
authors.initials: F
authors.lastname: Pacelli
authors.forename: Barbara
authors.initials: B
authors.lastname: Costantini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vizzielli
authors.forename: Pasquale Alessandro
authors.initials: PA
authors.lastname: Margariti
authors.forename: Giorgia
authors.initials: G
authors.lastname: Garganese
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000005:Abdomen / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D003964:Diaphragm / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies