title: Transabdominal cardiophrenic lymph node dissection (CPLND) via incised diaphragm replace conventional video-assisted thoracic surgery for cytoreductive surgery in advanced ovarian cancer.
abstract: OBJECTIVE
  The objective of this study is to describe the feasibility of the new approach, transabdominal CPLND, via incised diaphragm in patients with ovarian cancer by gynecologic oncologists instead of the conventional video-assisted thoracic surgery.
  
  
  METHODS
  From November 2008 to December 2011, 11 women (10 primary and 1 recurrent ovarian cancers) underwent CPLND for the extensive cytoreductive surgeries via incised muscle of the right diaphragm by gynecologic oncologists. All ≥5 mm tumors in CPLN, which were the criterion for suspicious malignancy on preoperative axial computed tomogram, were completely resected by gynecologic oncologists.
  
  
  RESULTS
  The median tumor size of the CPLN was 10mm (range, 7-17 mm) and metastasis was identified in 45% (5/11) of ≥5 mm CPLN on preoperative computed tomogram. The median number of harvested CPLND was 3 (range 1-12) and metastatic node was 1 (range, 0-10). There was no significant morbidity related to CPLND and mortality associated with surgery. Ten patients achieved the no gross residual disease and one patient accomplished gross residual-1, indicating residual disease measuring ≤1 cm in maximal diameter.
  
  
  CONCLUSIONS
  Transabdominal CPLND via incised diaphragm is feasible as a part of the cytoreductive surgery without significant morbidities by gynecologic oncologist. This procedure could substitute the conventional video-assisted thoracic surgery.
authors.affiliation: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea. hjyoo@ncc.re.kr
authors.forename: Heon Jong
authors.initials: HJ
authors.lastname: Yoo
authors.forename: Myong Cheol
authors.initials: MC
authors.lastname: Lim
authors.forename: Yong Jung
authors.initials: YJ
authors.lastname: Song
authors.forename: Yuh-Seock
authors.initials: YS
authors.lastname: Jung
authors.forename: Sun Ho
authors.initials: SH
authors.lastname: Kim
authors.forename: Chong Woo
authors.initials: CW
authors.lastname: Yoo
authors.forename: Sang-Yoon
authors.initials: SY
authors.lastname: Park
mesh_terms: D000368:Aged; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery*; D003964:Diaphragm / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D018200:Mixed Tumor, Mullerian / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013909:Thorax; D016896:Treatment Outcome