title: Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer.
abstract: OBJECTIVE
  The aim of this study was to assess the influence of video-assisted thoracic surgery (VATS) on our treatment decisions in FIGO III and IV ovarian cancer patients.
  
  
  METHODS
  Patients with ovarian cancer and suspected supra-diaphragmatic involvement (pleural effusions, pleural carcinomatosis, lung metastasis, or enlarged supra-diaphragmatic lymph nodes) at chest computer tomography (CT) scan underwent VATS with or without laparoscopy (LSC) to decide for primary cytoreduction or neoadjuvant chemotherapy. Operation time, VATS complications (intrapleural hematoma, secondary hemorrhage with intervention, pneumonia and empyema) and shift in the therapeutic strategy due to VATS were evaluated.
  
  
  RESULTS
  17 patients were included into this study (1 patient with FIGO stage IIIb, 1 with IIIc and 15 with stage IV). The median operation time for VATS only was 46.5 min (range: 20-50 min, n=3). Perioperatively, no complications occurred. After surgical staging, the tumor was confined to the abdomen in four patients in whom primary cytoreduction was attempted. All other 13 patients underwent neoadjuvant chemotherapy. VATS altered the therapeutic management in 6/17 ovarian cancer patients (3 times upstaging, 3 times downstaging). Negative predictive values (NPV) for local and diffuse pleural carcinomatosis ranged between 0.5 and 0.71.
  
  
  CONCLUSIONS
  In this case series, VATS in addition to LSC showed negligible morbidity related to surgery and a short operation time. We were able to improve the accuracy of the FIGO staging and assessed operability more reliably in these patients than through imaging techniques alone.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Freiburg, Germany, Hugstetter Strasse 55, 79106 Freiburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Klar
authors.forename: J
authors.initials: J
authors.lastname: Farthmann
authors.forename: M
authors.initials: M
authors.lastname: Bossart
authors.forename: C
authors.initials: C
authors.lastname: Stremmel
authors.forename: G
authors.initials: G
authors.lastname: Gitsch
authors.forename: B
authors.initials: B
authors.lastname: Passlick
authors.forename: G
authors.initials: G
authors.lastname: Pache
authors.forename: J
authors.initials: J
authors.lastname: Woll
authors.forename: A
authors.initials: A
authors.lastname: Hasenburg
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000556:secondary; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000628:therapy*; D016066:Pleural Effusion, Malignant / Q000175:diagnosis*; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000556:secondary; D011237:Predictive Value of Tests; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013997:Time Factors