Ha Xinyu, Feng Zheng, Wu Yangjun, Liu Ziqi, Ju Xingzhu, Wen Hao, Wu Xiaohua
Department of Gynecological Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
J Gynecol Oncol. 2025 May;36(3):e109. doi: 10.3802/jgo.2025.36.e109. Epub 2025 Apr 10.
Diaphragm is the common site of metastasis in advanced ovarian cancer. Diaphragmatic surgery is necessary to achieve complete resection. Relative complications also pose challenges to perioperative management. This study aims to explore the influencing factors and management strategies for perioperative complications of diaphragm surgery.
This study retrospectively included 396 patients who underwent diaphragmatic surgery for advanced ovarian cancer at Fudan University Shanghai Cancer Center from July 2015 to June 2022. Diaphragm surgical methods were classified, and perioperative complications were regarded according to Memorial Sloan Kettering Cancer Center criteria. Clinical characteristics and perioperative complications were analyzed to find correlations to establish the nomogram.
Among the 396 patients, 163 patients (41.2%) suffered from perioperative complications. Pleural effusion (33.1%) and pneumothorax (5.3%) were the most commonly reported. Patients with longer surgery duration (>3 hours) (p=0.003) and who underwent diaphragmatic incision surgery (p=0.004) had a higher incidence of postoperative complications. The incidence of postoperative pleural effusion was significantly higher in patients who underwent diaphragm full-thickness resection (49.3%) than diaphragmatic stripping (29.5%) (p=0.001), and patients who underwent diaphragm full-thickness resection are more likely to require drainage (p=0.001). Multi-variate analyses showed that stage IV tumor, long operation time, and diaphragm full-thickness resection are associated with postoperative pleural effusion.
Pleural effusion is the most common complication of diaphragmatic surgery in patients with ovarian cancer. Routine placement of prophylactic chest tubes is not appropriate for all patients undergoing diaphragmatic surgery. Our nomogram could help to predict its risk and indicate prophylactic management.
膈肌是晚期卵巢癌常见的转移部位。膈肌手术对于实现完整切除是必要的。相关并发症也给围手术期管理带来挑战。本研究旨在探讨膈肌手术围手术期并发症的影响因素及管理策略。
本研究回顾性纳入了2015年7月至2022年6月在复旦大学附属肿瘤医院接受晚期卵巢癌膈肌手术的396例患者。对膈肌手术方法进行分类，并根据纪念斯隆凯特琳癌症中心标准对围手术期并发症进行评估。分析临床特征与围手术期并发症之间的相关性以建立列线图。
在396例患者中，163例（41.2%）发生围手术期并发症。最常见的是胸腔积液（33.1%）和气胸（5.3%）。手术时间较长（>3小时）（p=0.003）以及接受膈肌切开手术（p=0.004）的患者术后并发症发生率较高。接受膈肌全层切除术的患者术后胸腔积液发生率（49.3%）显著高于膈肌剥除术患者（29.5%）（p=0.001），且接受膈肌全层切除术的患者更有可能需要引流（p=0.001）。多因素分析显示，IV期肿瘤、手术时间长和膈肌全层切除术与术后胸腔积液相关。
胸腔积液是卵巢癌患者膈肌手术最常见的并发症。常规放置预防性胸管并不适用于所有接受膈肌手术的患者。我们的列线图有助于预测其风险并指导预防性管理。
