Department of Obstetrics and Gynecology, Division on Gynecologic Oncology, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy.
Gynecol Oncol. 2010 Mar;116(3):497-501. doi: 10.1016/j.ygyno.2009.11.023. Epub 2009 Dec 11.
Upper abdominal spread of primary and recurrent ovarian cancer is often considered to be a major obstacle to achieve optimal residual disease at the end of surgery. In this study, we investigate the role of diaphragmatic debulking in the natural history of advanced and recurrent epithelial ovarian cancer patients, and the morbidity of this procedure according to clinico-surgical characteristics.
Data from 234 consecutive patients with primary and recurrent advanced ovarian cancer, operated at Catholic University of Rome and Campobasso from January 1, 2005 and December 31, 2008, were retrospectively reviewed.
Eighty-seven patients (37.2%) underwent a diaphragmatic surgery. Median age was 55 years (range 37-76). Diaphragmatic debulking was performed in 50 out of 120 patients at primary surgery (41.7%), in 16 out of 74 at interval debulking surgery (21.6%) and in 21 out of 40 secondary cytoreductions (52.5%). In the whole study population optimal residual disease at the end of surgery was achieved. The most frequent post-operative complication was pleural effusion, observed in 37 patients (42.5%). Presence of a post-operative pleural effusion was correlated liver mobilization (52.3% vs. 16%; p<0.0027) and large diaphragmatic disease (>5 cm) removal (54.1% vs. 23.5%; p<0.034).
Diaphragmatic surgery represents a crucial step in the debulking of advanced and recurrent ovarian cancer patients. Considering the natural history of advanced epithelial ovarian cancer and the rate of patients needing diaphragmatic debulking during primary cytoreduction, interval debulking surgery and secondary cytoreduction, this procedure should be present in the surgical repertoire of a gynecologic oncologist.
原发性和复发性卵巢癌的上腹部扩散通常被认为是手术结束时实现最佳残留疾病的主要障碍。在这项研究中，我们研究了膈切除术在晚期和复发性上皮性卵巢癌患者的自然史中的作用，以及根据临床手术特征，该手术的发病率。
回顾性分析了 2005 年 1 月 1 日至 2008 年 12 月 31 日在罗马天主教大学和坎波巴索连续接受原发性和复发性晚期卵巢癌手术的 234 例连续患者的数据。
87 例（37.2%）患者行膈切除术。中位年龄为 55 岁（范围 37-76 岁）。原发性手术中 50 例（41.7%）、间隔减瘤手术中 16 例（21.6%）、二次细胞减灭术 21 例（52.5%）行膈切除术。在整个研究人群中，手术结束时达到了最佳的残留疾病。最常见的术后并发症是胸腔积液，37 例（42.5%）患者出现胸腔积液。术后胸腔积液的存在与肝脏移动（52.3%对 16%；p<0.0027）和大膈疾病（>5 cm）切除（54.1%对 23.5%；p<0.034）相关。
膈切除术是晚期和复发性卵巢癌患者减瘤的关键步骤。考虑到晚期上皮性卵巢癌的自然史以及原发性细胞减灭术、间隔减瘤术和二次细胞减灭术期间需要膈切除术的患者比例，该手术应成为妇科肿瘤学家手术方法的一部分。
