title: Diaphragmatic resection preserving and repairing pericardium, splenectomy and distal pancreatectomy for ınterval debulkıng surgery of ovarıan cancer.
abstract: OBJECTIVE
  The majority of ovarian cancer patients are initially diagnosed at an advanced-stage [1]. Upper abdominal bulky metastasis cephalad to the greater omentum reported to be present in 42% of patients [2]. Many complex surgical procedures such as splenectomy, pancreatectomy, mobilization and partial resection of liver, porta hepatis dissection, diaphragmatic peritonectomy and resection are frequently performed to achieve complete resection of metastatic disease [3]. Our aim in this surgical film is to show the resection of a left sided diaphragmatic implant located beneath the heart, with dissection from the pericardium after entrance to the pericardial cavity. Additionally, step by step splenectomy with distal pancreatectomy also presented.
  
  
  METHODS
  A 67years-old woman referred to our clinic for interval debulking for advanced stage suboptimally debulked high grade serous ovarian carcinoma. The tumor invading distal pancreas, hilum and parenchyma of spleen is clearly seen on magnetic resonance imaging. Another implant was also visible on left side of the diaphragm. We achieved complete cytoreduction with no macroscopic disease at the end of the surgery.
  
  
  RESULTS
  She stayed at the intensive care unit for two days and in our clinic for seven days. We did not encounter any grade 3 or 4 adverse event in post-operative period.
  
  
  CONCLUSIONS
  The surgical treatment of ovarian cancer has evolved in time in favor of radical surgery. The surgical team should be highly motivated, skilled and experienced for this complex procedures, since being able to reach complete cytoreduction is the most important predictor of survival in ovarian cancer patients.
authors.affiliation: Kartal Lutfi Kirdar Training and Research Hospital, Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Semsi Denizer Caddesi, Kartal, 34865 Istanbul, Turkey. Electronic address: drdvatansever@gmail.com.
authors.forename: Dogan
authors.initials: D
authors.lastname: Vatansever
authors.affiliation: Kartal Lutfi Kirdar Training and Research Hospital, Department of General Surgery, Surgical Gastroenterology Unit, Semsi Denizer Caddesi, Kartal, 34865 Istanbul, Turkey. Electronic address: aeatici@gmail.com.
authors.forename: Ali Emre
authors.initials: AE
authors.lastname: Atici
authors.affiliation: Suleymaniye Gynecology and Maternity Training and Research Hospital, Gynecologic Oncology Unit, Süleymaniye Doğum Ve Çocuk Hastalıkları Eğitim Ve Araştırma Hastanesi Telsiz Mah., Balıklı Kazlıçeşme Yolu No: 1, Süleymaniye, 34116 Zeytinburnu/İstanbul, Turkey. Electronic address: drhsozen@gmail.com.
authors.forename: Hamdullah
authors.initials: H
authors.lastname: Sozen
authors.affiliation: Kartal Lutfi Kirdar Training and Research Hospital, Department of Obstetrics and Gynecology, Semsi Denizer Caddesi, Kartal, 34865 Istanbul, Turkey. Electronic address: sakin-onder@hotmail.com.
authors.forename: Onder
authors.initials: O
authors.lastname: Sakin
mesh_terms: D000368:Aged; D003964:Diaphragm / Q000601:surgery; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000601:surgery*; D010180:Pancreatectomy; D010496:Pericardium / Q000601:surgery; D013156:Splenectomy