01.12.2017 | Research article | Ausgabe 1/2017 Open Access

Diaphragmatic Surgery and Related Complications In Primary Cytoreduction for Advanced Ovarian, Tubal, and Peritoneal Carcinoma
- Zeitschrift:
- BMC Cancer > Ausgabe 1/2017
Background
Methods
Study patients
Diaphragmatic surgery
Perioperative morbidities
Data collection and statistical analyses
Results
Variables
|
|
---|---|
Median age (range), years
|
55 (25–77)
|
Median body mass index (range), kg/m
2
|
22.7 (15.0–32.9)
|
Site of disease
|
|
Ovary (%)
|
144 (96%)
|
Fallopian tube/peritoneum (%)
|
6 (4%)
|
Neo-adjuvant chemotherapy (%)
|
14 (9.3%)
|
Preoperative laboratory values
|
|
Median CA-125 (range), U/mL
|
1166 (57–5502)
|
Median total protein (range), g/dL
|
7.1 (4.1–9.6)
|
Median albumin (range), g/dL
|
3.9 (2.4–8.2)
|
Tumor stage
|
|
IIIC (%)
|
114 (76%)
|
IV (%)
|
36 (24%)
|
Histology
|
|
Serous (%)
|
134 (89.3%)
|
Non-serous (%)
|
16 (10.7%)
|
Presence of pleural effusion before surgery (%)
|
47 (31.3%)
|
Right
|
9 (6.0%)
|
Left
|
9 (6.0%)
|
Bilateral
|
29 (19.3%)
|
Preoperative pleural drainage (%)
|
7 (4.7%)
|
Presence of ascites at surgery (%)
|
141 (94%)
|
Median ascites volume (range), mL
|
2000 (20–7300)
|
Type of diaphragm surgery
|
|
Diaphragm peritonectomy (%)
|
124 (82.7%)
|
Diaphragm full-thickness resection (%)
|
26 (17.3%)
|
Cohort
(
n = 150)
|
DP
(
n = 124)
|
DFTR
(
n = 26)
|
P
|
|
---|---|---|---|---|
Laterality of diaphragm lesions (%)
|
||||
Right
|
95 (63.3%)
|
78 (62.9%)
|
17 (65.4%)
|
0.811
|
Left
|
1 (0.7%)
|
1 (0.8%)
|
0
|
|
Bilateral
|
54 (36.0%)
|
45 (36.3%)
|
9 (34.6%)
|
|
Perforation into pleural cavity (%)
|
65 (43.3%)
|
39 (31.5%)
|
26 (100%)
|
<0.001
|
TDDE (%)
|
34 (22.7%)
|
21 (16.9%)
|
13 (50.0%)
|
<0.001
|
Pleural nodule biopsy performed (%)
|
21 (14.0%)
|
15 (12.1%)
|
6 (23.1%)
|
0.248
|
Prophylactic chest tube placement (%)
|
8 (5.3%)
|
5 (4.0%)
|
3 (11.5%)
|
0.285
|
Mesh utilization in diaphragm repair (%)
|
4 (2.7%)
|
0
|
4 (15.4%)
|
<0.001
|
Extended procedures performed (%)
|
||||
Small bowel resection
|
5 (3.3%)
|
5 (4.0%)
|
0
|
0.660
|
Large bowel resection
|
48 (32.0%)
|
37 (29.8%)
|
11 (42.3%)
|
0.215
|
Splenectomy
|
18 (12.0%)
|
14 (11.3%)
|
4 (15.4%)
|
0.801
|
Partial pancreatectomy
|
5 (3.3%)
|
4 (3.2%)
|
1 (3.8%)
|
1.000
|
Partial hepatic resection
|
4 (2.7%)
|
4 (3.2%)
|
0
|
0.796
|
Resection of porta hepatis tumor
|
4 (2.7%)
|
3 (2.4%)
|
1 (3.8%)
|
1.000
|
Cholecystectomy
|
1 (0.7%)
|
1 (0.8%)
|
0
|
1.000
|
Stomia
|
15 (10.0%)
|
12 (9.7%)
|
3 (11.5%)
|
1.000
|
Resection of the tumor on the liver surface
|
23 (15.3%)
|
20 (16.1%)
|
3 (11.5%)
|
0.771
|
Resection of the tumor on the stomach surface
|
13 (8.7%)
|
10 8.1(%)
|
3 (11.5%)
|
0.850
|
Resection of the tumor in the gallbladder fossa
|
6 (4.0%)
|
6 (4.8%)
|
0
|
0.552
|
Residual disease (%)
|
||||
Complete cytoreduction
|
53 (35.3%)
|
42 (33.9%)
|
11 (42.3%)
|
0.649
|
Residual disease ≤1 cm
|
73 (48.7%)
|
61 (49.2%)
|
12 (46.2%)
|
|
Median operation time (range), minutes
|
180 (60–330)
|
180 (60–330)
|
195 (90–270)
|
0.576
|
Median EBL (range), mL
|
900 (100–5300)
|
900 (100–5300)
|
1000 (200–2200)
|
0.802
|
Intraoperative blood transfusion (%)
|
132 (88%)
|
109 (87.9%)
|
23 (88.5%)
|
0.937
|
Median transfusion amount (range), units
|
4.0 (1.0–15.0)
|
4.5 (1–15)
|
4 (2–13)
|
0.286
|
Planned intensive care unit stay (%)
|
46 (30.7%)
|
39 (30.6%)
|
8 (30.8%)
|
0.649
|
Median time interval from surgery to chemotherapy (range), days
|
14 (6–40)
|
14 (6–40)
|
14 (6–34)
|
0.272
|
Cohort
(
n = 150)
|
DP
(
n = 124)
|
DFTR
(
n = 26)
|
P
|
|
---|---|---|---|---|
All complications
|
||||
Ipsilateral pleural effusion (%)
|
50 (33.3%)
|
32 (25.8%)
|
18 (69.2%)
|
<0.001
|
Ipsilateral pneumothorax (%)
|
11 (7.3%)
|
8 (6.5%)
|
3 (11.5%)
|
0.623
|
Pulmonary embolism (%)
|
2 (1.3%)
|
2 (1.6%)
|
0
|
1.000
|
Pneumonia (%)
|
23 (15.3%)
|
20 (16.1%)
|
3 (11.5%)
|
0.771
|
Right hepatic vein rupture
|
1 (0.6%)
|
0
|
1 (3.8%)
|
1.000
|
Sub-diaphragmatic abscess
|
1 (0.6%)
|
1 (0.8%)
|
0
|
1.000
|
Postoperative bleeding (%)
|
1 (0.6%)
|
1 (0.8%)
|
0
|
1.000
|
Bowel obstruction (%)
|
10 (6.7%)
|
9 (7.3%)
|
1 (3.8%)
|
0.825
|
Pancreatic leak
|
1 (0.6%)
|
1 (0.8%)
|
0
|
1.000
|
Intestinal perforation
|
1 (0.6%)
|
1 (0.8%)
|
0
|
1.000
|
Heart arrhythmia
|
1 (0.6%)
|
1 (0.8%)
|
0
|
1.000
|
Wound infection/dehiscence
|
5 (3.3%)
|
3 (2.4%)
|
2 (7.7%)
|
0.447
|
Vaginal cuff infection
|
1 (0.6%)
|
1 (0.8%)
|
0
|
1.000
|
Urinary tract infection
|
1 (0.8%)
|
1 (0.8%)
|
0
|
1.000
|
MSKCC grading
|
||||
Grade 1–2 (%)
|
82 (54.7%)
|
66 (53.2%)
|
16 (61.5%)
|
0.010
|
Grade 3–5 (%)
|
27 (18.0%)
|
15 (12.1%)
|
12 (46.2%)
|
|
Grade 3–5 complications
a
|
||||
Symptomatic pleural effusion requiring drainage
|
21 (14.0%)
|
11 (8.9%)
|
10 (38.5%)
|
<0.001
|
Symptomatic pneumothorax requiring thoracostomy tube
|
1 (0.6%)
|
0
|
1 (3.8%)
|
1.000
|
Right hepatic vein rupture requiring intra-operative repair and transfusion
|
1 (0.6%)
|
0
|
1 (3.8%)
|
1.000
|
Bleeding requiring return to operating room
|
1 (0.6%)
|
1 (0.8%)
|
0
|
1.000
|
Pancreatic leak requiring drainage
|
1 (0.6%)
|
1 (0.8%)
|
0
|
1.000
|
Intestinal perforation requiring return to the operating room
|
1 (0.6%)
|
1 (0.8%)
|
0
|
1.000
|
Wound dehiscence requiring delayed repair
|
1 (0.6%)
|
1 (0.8%)
|
0
|
1.000
|
Univariate
|
||||
Parameters
|
Pleural effusions
|
Pleural drainage
|
||
P value
|
P value
|
|||
Age (>55 years old)
|
0.908
|
0.080
|
||
Tumor stage (IV vs. IIIC)
|
<0.001
|
0.009
|
||
Preoperative pleural effusion
|
0.215
|
0.831
|
||
Ascites >2000 mL
|
0.558
|
0.878
|
||
CA-125 > 1166 U/mL
|
0.729
|
0.482
|
||
Albumin <3.9 g/dL
|
0.568
|
0.815
|
||
Diaphragmatic surgery (DFTR vs. DP)
|
<0.001
|
<0.001
|
||
Perforation into pleural cavity
|
0.996
|
0.996
|
||
TDDE
|
0997
|
<0.001
|
||
Pleural nodule biopsy
|
0.998
|
0.995
|
||
Operating time > 180 min
|
<0.001
|
0.015
|
||
Estimated blood loss >900 mL
|
0.249
|
0.442
|
||
Intraoperative blood transfusion >4.0 units
|
0.016
|
0.719
|
||
Multivariate
|
||||
Parameters
|
Pleural effusions
|
Pleural drainage
|
||
HR (95% CI)
|
P value
|
HR (95% CI)
|
P value
|
|
Tumor stage (IV vs. IIIC)
|
17.2 (4.5–66.7)
|
<0.001
|
4.5 (0.8–25.7)
|
0.086
|
Diaphragmatic surgery (DFTR vs. DP)
|
4.9 (1.2–19.9)
|
0.028
|
5.9 (1.5–23.6)
|
0.011
|
TDDE
|
/
|
/
|
28.3 (4.9–160.8)
|
<0.001
|
Operating time > 180 min
|
15.4 (4.3–55.5)
|
<0.001
|
2.2 (0.6–8.6)
|
0.242
|
Intraoperative blood transfusion >4.0 units
|
0.7 (0.2–2.3)
|
0.581
|
/
|
/
|