Transabdominal cardiophrenic lymph node dissection (CPLND) via incised diaphragm replace conventional video-assisted thoracic surgery for cytoreductive surgery in advanced ovarian cancer

Objective. The objective of this study is to describe the feasibility of the new approach, transabdominal CPLND, via incised diaphragm in patients with ovarian cancer by gynecologic oncologists instead of the conventional Niideo-assisted thoracic surgery. Methods. From November 2008 to December 2011,11 women (10 primary and 1 recurrent ovarian cancers) underwent CPLND for the extensive cytoreductive surgeries via incised muscle of the right diaphragm by gynecologic oncologists. All >= 5 mm tumors in CPLN, which were the criterion for suspicious malignancy on preoperative axial computed tomogram, were completely resected by gynecologic oncologists. Results. The median tumor size of the CPLN was 10 mm (range, 7-17 mm) and metastasis was identified in 45% (5/11) of >= 5 mm CPLN on preoperative computed tomogram. The median number of harvested CPLND was 3 (range 1-12) and metastatic node was 1 (range, 0-10). There was no significant morbidity related to CPLND and mortality associated with surgery. Ten patients achieved the no gross residual disease and one patient accomplished gross residual-1, indicating residual disease measuring <= 1cm in maximal diameter. Conclusion. Transabdominal CPLND via incised diaphragm is feasible as a part of the cytoreductive surgery without significant morbidities by gynecologic oncologist. This procedure could substitute the conventional video-assisted thoracic surgery. (C) 2013 Published by Elsevier Inc.