title: Cytoreduction of diaphragmatic metastasis from ovarian cancer with involvement of the liver using a ventral liver mobilization technique.
abstract: OBJECTIVE
  Upper abdominal spreading of advanced-stage ovarian cancer often involves the diaphragm. In addition, bulky diaphragmatic tumors occasionally infiltrate the liver. Here, we describe our early experiences with a ventral liver mobilization technique to remove diaphragmatic tumors with liver involvement.
  
  
  METHODS
  Two patients with primary ovarian cancer and 1 patient with recurrent ovarian cancer underwent en bloc resections of a diaphragmatic tumor together with the full-thickness diaphragm and the liver tissue using a ventral liver mobilization technique. The surgical technique involved a full-thickness division of the diaphragm at the central tendon and a ventral mobilization of the right lobe of the liver, with entry into the pleural cavity. During the parenchymal transection of the liver, the posterior area of the right lobe of the liver was pressed using the surgeon's hand to reduce bleeding from the resection surface. After the completion of the en bloc resection, the diaphragmatic opening was closed using running sutures.
  
  
  RESULTS
  All the diaphragmatic tumors were completely removed without severe bleeding in the current series. No intraoperative or postoperative complications occurred.
  
  
  CONCLUSIONS
  Diaphragmatic tumors with involvement of the liver can be safely and effectively removed using a ventral liver mobilization technique. This surgical procedure may be suitable for the management of bulky diaphragmatic tumors in select patients.
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo 135-8550, Japan. Electronic address: kazuyosikato@gmail.com.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kato
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo 135-8550, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Katsuda
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo 135-8550, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takeshima
mesh_terms: D000328:Adult; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D003964:Diaphragm / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery*; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000556:secondary / Q000601:surgery*; D009362:Neoplasm Metastasis; D010051:Ovarian Neoplasms / Q000473:pathology*
keywords: Cytoreduction; Diaphragm resection; Liver mobilization; Ovarian cancer