Diaphragmatic peritonectomy versus full thickness diaphragmatic resection and pleurectomy during cytoreduction in patients with ovarian cancer.
OBJECTIVE
Compare the surgical morbidity of diaphragmatic peritonectomy versus full thickness diaphragmatic resection with pleurectomy at radical debulking.


METHODS
Prospective cohort study at the Oxford University Hospital.


METHODS
All debulking with diaphragmatic peritonectomy and/or full thickness resection with pleurectomy in the period from April 2009 to March 2012 were part of the study. Analysis is focused on the intra- and postoperative morbidity.


RESULTS
42 patients were eligible for the study, 21 underwent diaphragmatic peritonectomy (DP, group 1) and 21 diaphragmatic full thickness resection (DR, group 2). Forty patients out of 42 (93%) had complete tumour resection with no residual disease. Histology confirmed the presence of cancer in diaphragmatic peritoneum of 19 patients out of 21 in group 1 and all 21 patients of group 2. Overall complications rate was 19% in group 1 versus 33% in group 2. Pleural effusion rate was 9.5% versus 14.5% and pneumothorax rate was 14.5% only in group 2. Two patients in each group required postoperative chest drains (9.5%).


CONCLUSIONS
Diaphragmatic surgery is an effective methods to treat carcinomatosis of the diaphragm. Patients in the pleurectomy group experienced pneumothorax and a higher rate of pleural effusion, but none had long-term morbidity or additional surgical interventions.
Department of Gynaecologic Oncology, Oxford Cancer Centre, Churchill Hospital, Oxford University Hospital, Oxford OX3 7LJ, UK.
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Pathiraja
Department of Gynaecologic Oncology, Oxford Cancer Centre, Churchill Hospital, Oxford University Hospital, Oxford OX3 7LJ, UK.
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Garruto-Campanile
Department of Gynaecologic Oncology, Oxford Cancer Centre, Churchill Hospital, Oxford University Hospital, Oxford OX3 7LJ, UK.
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Tozzi
D003964:Diaphragm / Q000473:pathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010537:Peritoneum / Q000473:pathology / Q000601:surgery*; D010994:Pleura / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome