title: Diaphragmatic peritonectomy vs. full thickness resection with pleurectomy during Visceral-Peritoneal Debulking (VPD) in 100 consecutive patients with stage IIIC-IV ovarian cancer: A surgical-histological analysis.
abstract: OBJECTIVE
  To compare the surgical and histological outcomes of diaphragmatic peritonectomy vs. full thickness resection with pleurectomy during Visceral-Peritoneal Debulking.
  
  
  METHODS
  Service evaluation protocol (Trust number 3265). All patients with stage IIIC-IV ovarian cancer who had diaphragmatic surgery between April 2009 and November 2013 were included. Clinical notes and histology reports were reviewed. Additional histology sections were undertaken. Patients were divided in Groups 1 (peritonectomy) and 2 (pleurectomy). The outcomes of interest were: surgical (intra- and post-operative morbidity, pulmonary morbidity, mortality, rate of complete resection) and histological (rate of diaphragmatic peritoneum, muscle and pleural involvement, rate of microscopic diaphragmatic free margins).
  
  
  RESULTS
  Sixty four patients had diaphragmatic peritonectomy (Group 1), 36 patients full thickness diaphragmatic resection with pleurectomy (Group 2). There was no significant difference in the rate of mortality (3% in both groups), overall intra- and post-operative morbidity (32.8% vs. 38.8%), pulmonary morbidity (9.3% vs. 19%, P=0.14). Histology showed tumor invasion in the diaphragmatic peritoneum (96%), muscle (28%) and pleura (19.4%). Microscopic free margins were seen in 86% vs. 92% in Groups 1 and 2.
  
  
  CONCLUSIONS
  Our study demonstrated that, in patients with ovarian cancer, diaphragmatic involvement extends to the muscle in almost 30% and to the pleura in 20% of the patients. Overall and specific morbidity was not significantly different when comparing peritonectomy vs. pleurectomy.
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Old Road, Headington, Oxford, UK.
authors.forename: Hooman
authors.initials: H
authors.lastname: Soleymani Majd
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Old Road, Headington, Oxford, UK.
authors.forename: Federico
authors.initials: F
authors.lastname: Ferrari
authors.affiliation: Department of Pathology, Oxford University Hospital, Old Road, Headington, Oxford, UK.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Manek
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Old Road, Headington, Oxford, UK.
authors.forename: Kumar
authors.initials: K
authors.lastname: Gubbala
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Old Road, Headington, Oxford, UK.
authors.forename: Riccardo Garruto
authors.initials: RG
authors.lastname: Campanile
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Old Road, Headington, Oxford, UK.
authors.forename: Kieran
authors.initials: K
authors.lastname: Hardern
authors.affiliation: Department of Gynaecologic Oncology, Oxford University Hospital, Old Road, Headington, Oxford, UK. Electronic address: Roberto.Tozzi@obs-gyn.ox.ac.uk.
authors.forename: Roberto
authors.initials: R
authors.lastname: Tozzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects*; D003964:Diaphragm / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009375:Neoplasms, Glandular and Epithelial / Q000556:secondary / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology*; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D010537:Peritoneum / Q000473:pathology / Q000601:surgery; D010997:Pleural Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate; D055815:Young Adult