Department of Women's and Reproductive Health, University of Oxford, Old Road, Headington, Oxford, UK.
J Gynecol Oncol. 2020 Sep;31(5):e71. doi: 10.3802/jgo.2020.31.e71.
To describe the surgical technique and evaluate the safety, feasibility and efficacy of laparoscopic diaphragmatic peritonectomy during Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer (OC).
This report is part of a Service Evaluation Protocol (Trust number 3267) on laparoscopy in patients with OC following neo-adjuvant chemotherapy. Between April 2015 and November 2017, all patients underwent to exploratory laparoscopy and a selected court was offered laparoscopic VPD. Laparoscopic diaphragmatic surgery was considered if there was no full thickness involvement. Primary endpoints of this part of the study were the safety, feasibility and efficacy of laparoscopic diaphragmatic peritonectomy. We report the surgical technique and outcomes.
Ninety-six patients underwent diaphragmatic surgery during the study period. Fifty patients (52.1%) had intra-operative exclusion criteria and/or full thickness diaphragmatic resection, 46 (47.9%) had peritonectomy and were included in the study. Laparoscopic diaphragmatic peritonectomy was performed in 21 patients (45.4%, group 1), while in 25 patients (54.6%, group 2) laparotomy was necessary. Extent of disease and complexity of surgery were similar. Reasons for conversions were disease coalescing the liver to the diaphragm preventing safe mobilization (22 patients) and accidental pleural opening (3 patients). Overall, intra- and post-operative morbidity was lower in group 1 and pulmonary specific morbidity was very low.
Diaphragmatic peritonectomy can be safely accomplished by laparoscopy in almost half of the patients with OC whose disease is limited to the diaphragmatic peritoneum.
描述腹腔镜膈肌腹膜切除术的手术技术，并评估其在接受新辅助化疗后的 IIIC-IV 期卵巢癌（OC）患者内脏腹膜廓清术（VPD）中的安全性、可行性和疗效。
本报告是一项关于 OC 患者新辅助化疗后腹腔镜检查的服务评估方案（信托编号 3267）的一部分。在 2015 年 4 月至 2017 年 11 月期间，所有患者均接受了腹腔镜探查术，部分患者接受了腹腔镜 VPD。如果没有全层受累，则考虑进行腹腔镜膈肌手术。本研究的主要终点是腹腔镜膈肌腹膜切除术的安全性、可行性和疗效。我们报告手术技术和结果。
在研究期间，96 例患者接受了膈肌手术。50 例患者（52.1%）因术中排除标准和/或全层膈肌切除而无法进行手术，46 例（47.9%）行腹膜切除术并纳入研究。21 例（45.4%，第 1 组）患者行腹腔镜膈肌腹膜切除术，25 例（54.6%，第 2 组）患者行剖腹手术。疾病的严重程度和手术的复杂性相似。转换的原因是肝脏与膈肌融合，妨碍了安全的游离（22 例）和意外的胸膜破裂（3 例）。总体而言，第 1 组的术中及术后发病率较低，肺部特异性发病率非常低。
对于疾病局限于膈肌腹膜的 OC 患者，近一半的患者可通过腹腔镜安全完成膈肌腹膜切除术。
