DIAPHRAGMATIC SURGERY DURING PRIMARY CYTOREDUCTION FOR ADVANCED OVARIAN CANCER: PERITONEAL STRIPPING VERSUS DIAPHRAGMATIC RESECTION.
Disclosure : Authors do not have any poetntial conflict of interests.
5 slide(s) – English – 2011-09-11
Background: Standard approach for advanced ovarian cancer medically stable patients should be primary cytoreduction following platinum-based chemotherapy. The aim of surgical effort should be the complete removal of all visible disease. Our objective is to compare perioperative features, postoperative complications, and secondarily oncological outcomes of patients who underwent diaphragmatic stripping compared to those who underwent diaphragmatic resection for advanced ovarian cancer. Material and Methods: 112 cases were identified, among them 79 underwent diaphragmatic stripping and 33 underwent diaphragmatic full thickness resection. Data collected included patients’ age, all perioperative details as well as pathologic findings, FIGO stage, adjuvant therapy and follow-up data. Results: Larger residual tumor (mean 5.1 vs. 1.6 mm, respectively; p<0.01) but shorter operating time (25 minutes shorter operative time, p=0.07) were observed in the stripping group. Higher postoperative pleural effusions rate (63.6% vs. 37.9%, p=0.01), but no differences in the remaining complications, were observed in the resection group. After a mean of 31 months of follow-up, disease free survival rates were 27.8% in the stripping group and 39.4% in the resection group (p=0.04). No significant differences were observed for overall survival. Conclusions: diaphragmatic surgery at the time of primary cytoreductive surgery for advanced ovarian cancer, may contribute to the achievement of complete cytoreduction with low perioperative complication rate, full thickness resection is preferable if peritoneum stripping will not achieve a complete removal of the disease.