Pulmonary morbidity of diaphragmatic surgery for stage III/IV ovarian cancer

Objective  To determine the morbidity of diaphragmatic peritonectomy.
Design  Prospective cohort study.
Setting  A Gynecology Department of a University Hospital.
Population  From 2005 to 2007, thirty-seven consecutive patients underwent surgery for stage IIIC or IV ovarian cancer.
Methods  Patients were separated into a diaphragmatic surgery group ( n  = 18) and a control group ( n  = 19). Diaphragmatic surgery may consist of coagulation, stripping or muscle resection.
Main outcome measures  Postoperative course and outcome were analysed.
Results  Patients in group 1 (diaphragmatic surgery) underwent more intestinal resection (89% versus 37%, P  = 0.01) and pelvic (94% versus 63%, P  = 0.02) or para-aortic lymphadenectomy (94% versus 53%, P  = 0.04). Neither the mean estimated blood loss (960 ml versus 909 ml) nor the rates of intra-operative blood transfusion (11 versus 9) were significantly different between the two groups. The mean operative time was higher in group 1 (480 minutes versus 316 minutes, P  < 0.05). There were thirteen postoperative complications in group 1 and eight in group 2 ( P  = 0.065). In group 1, the main complication was pleural effusion (seven cases): four patients required secondary pleural drainage, two required only pleural puncture and one had both procedures. There were more complete cytoreduction in group 1 than in group 2 (89% versus 63%, P  = 0.068).
Conclusions  Diaphragm peritonectomies and resections are an effective way to cytoreduce diaphragm carcinomatosis and increase the rate of optimal debulking surgery. Such procedures frequently result in pleural effusion, but with no long-term morbidity.