Surgical outcomes of diaphragmatic resection during cytoreductive surgery for advanced gynecological ovarian neoplasia: A randomized single center clinical trial - DRAGON

• Published in: Gynecologic oncology Vol. 164; no. 2; pp. 271 - 277
• Main Authors: Cianci, S., Fedele, C., Vizzielli, G., Pasciuto, T., Gueli Alletti, S., Cosentino, F., Chiantera, V., Fagotti, A., Scambia, G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022
• Subjects: Adult; Aged; Carcinoma, Ovarian Epithelial - pathology; Carcinoma, Ovarian Epithelial - surgery; Chest Tubes; Cytoreduction Surgical Procedures - methods; Diaphragm - surgery; Diaphragmatic resection; Diaphragmatic surgery; Female; Humans; Intraoperative Care - methods; Logistic Models; Middle Aged; Ovarian cancer; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Pleural effusion; Pleural Effusion - prevention & control; Pneumothorax; Postoperative Complications - prevention & control; Thoracostomy - methods; Thoracostomy tube; Diaphragmatic surgery; Pleural effusion; Pneumothorax; Thoracostomy tube; Diaphragmatic resection; Ovarian cancer
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2021.11.012

Ovarian cancer (OC) represent nearly 4% of gynecologic malignancies and it is often diagnosed at advanced stage. Diaphragmatic surgery, a fundamental step of advanced stage ovarian cancer (ASOC) debulking surgery, is associated with a high post-operative complication incidence, which is supposedly reduced with thoracostomy tube placement. We assessed the role of intra-operative thoracostomy tube placement, as a prevention measure for post-operative complications, after diaphragmatic resection. This was a single center prospective randomized trial. Ovarian cancer patients, who underwent mono-lateral diaphragmatic resection, were randomized 1:1 into two arms. Arm A included patients receiving intra-operative thoracostomy tube placement (TP); Arm B patients did not receive thoracostomy tube placement (NTP). After surgery, all patients underwent seriate chest x-ray and ultrasound to record thoracic complications. Statistical analysis included uni- and multivariable logistic regression model (proportional odds model). Three hundred seventy-one patients were screened and 88 patients were enrolled: 44 in arm A and B, respectively. No statistically significant differences for intra-operative (p = 0.291) and any grade of post-operative complication (p = 0.072) were detected, while 6.8% of patients in arm A and 22.7% in arm B experienced severe respiratory symptoms (p = 0.035); 18.2% of patients in arm A had a moderate/large pleural effusion versus 65.9% in arm B (p < 0.0001). At multivariable analysis, results confirmed that the NTP-group had a higher risk to receive post-operative thoracostomy tube placement due to pleural effusion than the TP-group (odds ratio [95% Confidence Interval] = 14.5 [3.7–57.4]). Thoracostomy intra-operative tube placement after diaphragmatic resection is effective to prevent post-operative thoracic complications. The extension of resection does not influence outcomes and the risk of post-operative thoracentesis or TP remain elevated. •One of the most frequent complication of ovarian cancer debulking is pleural effusion.•The diaphragmatic surgery during ovarian cancer debulking is a frequent procedure.•The use of intra-operatory chest tube to prevent thoracic complication is still debated.•The use of chest tube after diaphragmatic resection seems to give some benefits in terms of post-operatory complications.