Full-thickness diaphragmatic resection with simple and secure closure to accomplish complete cytoreductive surgery for patients with ovarian cancer

Objective. The diaphragm is a common site of metastasis in patients with primary ovarian cancer. While most diaphragmatic implants are superficial, invasive disease can occur. This report evaluates the use of full-thickness diaphragmatic resection in completely cytoreduced ovarian cancer. Methods. A prospective record of all patients with ovarian cancer treated between May 1, 2002, and September 30, 2003, was kept. Seven of the 37 patients required full-thickness diaphragmatic resection to achieve complete cytoreduction. The surgical technique and outcome as well as the clinical course and disease status were monitored. Results. Full-thickness diaphragmatic metastases were resected and diaphragmatic defects were closed with #1 loop-PDS suture in a mass closure technique. In addition to diaphragm resections, a variety of other procedures were performed to achieve complete cytoreduction. Intraoperative blood loss ranged from 800 to 2500 ml. Operating room time ranged from 3.5 to 7 h. No chest tube placements were required. The length of hospitalization ranged from 10 to 24 days. Paclitaxel and carboplatin was administered to each patient without the need for dose reductions or treatment delays. Complete clinical response was achieved in six of seven patients. One patient died with disease 4 months after surgery. Follow-up ranged from 4 to 21 months. Conclusions. Diaphragmatic resection is feasible and has minimal morbidity. The use of a loop-PDS suture to close the diaphragmatic defect adds ease and security to the procedure. If complete cytoreduction can be accomplished with the use of this procedure, it is conceivable that benefits in clinical outcomes may be offered to patients with aggressive, advanced ovarian cancer. (C) 2004 Elsevier Inc. All rights reserved.