title: Success rate and safety of tumor debulking with diaphragmatic surgery for advanced epithelial ovarian cancer and peritoneal cancer.
abstract: OBJECTIVE
  In advanced epithelial ovarian and peritoneal cancer, residual tumor diameter correlates with prognosis; therefore, maximum debulking and optimal surgery (OS) for residual tumors <1 cm is warranted. Here, we clarified the efficacy of tumor debulking with diaphragmatic surgery (DS).
  
  
  METHODS
  In 45 patients with epithelial ovarian or peritoneal cancer who underwent DS (ten, full-thickness resection; 35, stripping) between January 2010 and December 2013 at two related institutions, we retrospectively evaluated OS safety and success by surgical duration, blood loss, complications, hospitalization stay, and residual tumor diameter and site.
  
  
  RESULTS
  Blood loss was 4,090.8 and 2,847.9 mL; surgical duration was 485.2 and 479.5 min; hospitalization stay was 21.7 and 24.8 days; and complications included intraoperative thoracotomy in 17 and 7 patients, unexpected thoracotomy in 11 and 3, chest drain insertion in one and three, and pleural effusion in 14 and 7, in the primary debulking surgery (PDS) and interval debulking surgery (IDS) groups, respectively. OS was successful in all patients with complete surgery (CS: no residual tumor) achieved in 16 (50.0%) and 9 (69.2%), residual tumor diameter < 5 mm in 11 (34.4%) and 2 (15.4%), and residual tumor diameter < 1 cm in 5 (15.6%) and 2 (15.4%) in the PDS and IDS groups, respectively.
  
  
  CONCLUSIONS
  Tumor debulking surgery with DS resulted in controllable blood loss, and OS was successful in all patients without severe complications or postoperative treatment delay. Currently, OS is considered to have very few benefits over CS; thus, the success rate of CS rate should be improved while maintaining safety.
authors.affiliation: Department of Obstetrics/Gynecology, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-Ku, Tokyo, 105, Japan, smotoaki@jikei.ac.jp.
authors.forename: Motoaki
authors.initials: M
authors.lastname: Saitou
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iida
authors.forename: Hiromi
authors.initials: H
authors.lastname: Komazaki
authors.forename: Chikage
authors.initials: C
authors.lastname: Narui
authors.forename: Kanae
authors.initials: K
authors.lastname: Matsuno
authors.forename: Ayako
authors.initials: A
authors.lastname: Kawabata
authors.forename: Kazu
authors.initials: K
authors.lastname: Ueda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanabe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takakura
authors.forename: Seiji
authors.initials: S
authors.lastname: Isonishi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasaki
authors.forename: Aikou
authors.initials: A
authors.lastname: Okamoto
mesh_terms: D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D003964:Diaphragm / Q000473:pathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome