Department of Human Pathology of Adult and Childhood "G. Barresi", University Hospital "G. Martino", Messina, Italy; Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Gynecol Oncol. 2022 Feb;164(2):271-277. doi: 10.1016/j.ygyno.2021.11.012. Epub 2021 Nov 26.
Ovarian cancer (OC) represent nearly 4% of gynecologic malignancies and it is often diagnosed at advanced stage. Diaphragmatic surgery, a fundamental step of advanced stage ovarian cancer (ASOC) debulking surgery, is associated with a high post-operative complication incidence, which is supposedly reduced with thoracostomy tube placement. We assessed the role of intra-operative thoracostomy tube placement, as a prevention measure for post-operative complications, after diaphragmatic resection.
This was a single center prospective randomized trial. Ovarian cancer patients, who underwent mono-lateral diaphragmatic resection, were randomized 1:1 into two arms. Arm A included patients receiving intra-operative thoracostomy tube placement (TP); Arm B patients did not receive thoracostomy tube placement (NTP). After surgery, all patients underwent seriate chest x-ray and ultrasound to record thoracic complications. Statistical analysis included uni- and multivariable logistic regression model (proportional odds model).
Three hundred seventy-one patients were screened and 88 patients were enrolled: 44 in arm A and B, respectively. No statistically significant differences for intra-operative (p = 0.291) and any grade of post-operative complication (p = 0.072) were detected, while 6.8% of patients in arm A and 22.7% in arm B experienced severe respiratory symptoms (p = 0.035); 18.2% of patients in arm A had a moderate/large pleural effusion versus 65.9% in arm B (p < 0.0001). At multivariable analysis, results confirmed that the NTP-group had a higher risk to receive post-operative thoracostomy tube placement due to pleural effusion than the TP-group (odds ratio [95% Confidence Interval] = 14.5 [3.7-57.4]).
Thoracostomy intra-operative tube placement after diaphragmatic resection is effective to prevent post-operative thoracic complications. The extension of resection does not influence outcomes and the risk of post-operative thoracentesis or TP remain elevated.
卵巢癌（OC）占妇科恶性肿瘤的近 4%，通常在晚期诊断。膈切除术是晚期卵巢癌（ASOC）减瘤术的基本步骤，其术后并发症发生率较高，而胸腔引流管的放置可降低这种风险。我们评估了在膈切除术后放置术中胸腔引流管作为预防术后并发症的措施的作用。
这是一项单中心前瞻性随机试验。接受单侧膈切除术的卵巢癌患者以 1:1 的比例随机分为两组。A 组患者术中放置胸腔引流管（TP）；B 组患者未放置胸腔引流管（NTP）。手术后，所有患者均接受连续胸部 X 线和超声检查以记录胸部并发症。统计分析包括单变量和多变量逻辑回归模型（比例优势模型）。
筛选了 371 名患者，纳入 88 名患者：分别有 44 名患者入组 A 组和 B 组。术中（p=0.291）和任何级别的术后并发症（p=0.072）均无统计学差异，但 A 组 6.8%的患者和 B 组 22.7%的患者出现严重呼吸症状（p=0.035）；A 组 18.2%的患者出现中等/大量胸腔积液，而 B 组 65.9%的患者出现中等/大量胸腔积液（p<0.0001）。多变量分析结果证实，与 TP 组相比，NTP 组因胸腔积液而接受术后胸腔引流管放置的风险更高（比值比[95%置信区间]为 14.5[3.7-57.4]）。
膈切除术后放置术中胸腔引流管可有效预防术后胸部并发症。延长切除术范围不会影响结局，术后胸腔穿刺或 TP 的风险仍然较高。
