Diaphragm resection for ovarian cancer: technique and short-term complications.

Objective: Diaphragm resection (DR) is occasionally necessary to achieve optimal cytoreductive surgery in ovarian carcinoma (OC). In a recent survey of the SGO membership, bulky diaphragm disease was one of the most common justifications for suboptimal debulking (Gynecol. Oncol. 82 (2001) 489). The aim of this study was to assess postoperative complications of DR in OC.

Methods: Retrospective chart review of all patients with OC who underwent DR from January 1988 through December 2001 at Mayo Clinic.

Results: We identified 41 women who underwent DR for OC. DR was performed during debulking for recurrent disease in 85%. Most patients (95%) underwent associated radical debulking procedures including bowel resection (51%), hepatic resection (27%), and splenectomy (17%). Full-thickness diaphragmatic lesions were present in 85% of specimens. Residual disease was classified as no gross residual in 80% of cases and <1 cm in 10%. Postoperative complications requiring treatment occurred in eight cases: pneumothorax (two cases, definitely attributable to DR); symptomatic pleural effusion (four cases, possibly attributable to DR); one case each of subphrenic abscess and gastro-pleural fistula (most likely unrelated to DR).

Conclusions: (1) DR as part of cytoreductive surgery for ovarian cancer carries comparable risks to other radical debulking procedures. (2) The majority of complications are expected outcomes after entrance into the pleural cavity and generally manageable with chest tube. (3) DR is a useful adjunct to other radical debulking procedures and can eliminate isolated bulky diaphragmatic disease as an obstacle to optimal cytoreductive surgery for patients with ovarian cancer.