Abstract
Objective
To evaluate a novel technique for diaphragmatic full-thickness resection (DFTR) using
a vascular stapler to perform cytoreductive surgeries in patients with advanced ovarian
cancer.
Study Design
Single-center retrospective analysis of consecutive patients with advanced-stage ovarian
cancer undergoing stapled diaphragmatic full-thickness resections (S-DFTRs) as part
of cytoreductive surgeries between January 2018 and June 2022, according to the IDEAL
recommendations.
Results
Fifteen patients underwent cytoreductive surgeries with S-DFTRs. The median operative
time was 300 (114–547) minutes. Cytoreduction was considered complete in all cases.
All S-DFTRs were performed on the right diaphragm. Concomitant left diaphragmatic
peritoneal stripping was performed in 5 cases (33.3%) and was associated with a conventional
DFTR in 1 case (6.7%). Prophylactic intraoperative tube thoracostomy was never required.
Four patients (26.7%) were admitted to the intensive care unit. Pleural effusion was
observed in 9 patients (60.0%), and 4 (26.7%) required a postoperative pigtail catheter
thoracostomy. Three patients (20.0%) required catheter placement on the right hemithorax
(ipsilaterally to the S-DFTR) and 2 patients (13.3%) required catheters on the left
hemithorax (contralaterally to the S-DFTR). Pneumothorax requiring tube thoracostomy
was observed in 1 case (6.7%) on the left hemithorax (contralaterally to the S-DFTR).
Pulmonary embolism and pneumonia were both observed once (6.7%). The median hospitalization
length was 14 (5–36) days. During the follow-up, 6 patients (40.0%) had a recurrence,
but none involved the pleura or the diaphragm. According to the IDEAL classification,
this study could be ranked as stage 2a (development).
Conclusions
This technique appears to be a fast and safe method for performing diaphragmatic cytoreductive
surgeries and could reduce postoperative complications.
Abbreviations:
DFTR (diaphragmatic full-thickness resection), S-DFTR (stapled diaphragmatic full-thickness resection), SCS (surgical complexity score), PCI (peritoneal carcinomatosis index), ICU (intensive care unit), CD (Clavien-Dindo classification), ASA (American Society of Anesthesiologists)Keywords
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Article Info
Publication History
Published online: October 21, 2022
Accepted:
October 13,
2022
Received in revised form:
October 7,
2022
Received:
August 16,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
