ABSTRACT
OBJECTIVE: To introduce a systematic classification of diaphragmatic surgery in patients with ovarian cancer based on disease spread and surgical complexity.METHODS: For all consecutive patients who underwent diaphragmatic surgery during Visceral-Peritoneal debulking (VPD) in the period 2009–2017, we extracted: initial surgical finding, extent of liver mobilization and type of procedure. Combining these features, we aimed to classify the surgical procedures necessary to tackle different presentation of diaphragmatic disease. We also report histology, intra- and post-operative specific complication rate based on the classification.RESULTS: A total of 170 patients were included in this study, 110 (64.7%) had a peritonectomy, while 60 (35.3%) had a full thickness resection with pleurectomy. We identified 3 types of surgical procedures. Type I treated 28 out of 170 patients (16.5%) who only had anterior diaphragm disease, needed no liver mobilization, included peritonectomy and had no morbidity recorded. Type II pertained to 105 out of 170 patients (61.7%) who had anterior and posterior disease, needed partial and sometimes full liver mobilization, had a mix of peritonectomy and full thickness resection, and experienced 10% specific morbidity. Type III included 37 out of 170 patients (21.7%) who needed full mobilization of the liver, always had full thickness resection, and suffered 30% specific morbidity.CONCLUSION: Diaphragmatic surgery can be classified in 3 types. The adoption of this classification can facilitate standardization of the surgery, comparison of data and define the expertise required. Finally, this classification can be a benchmark to establish the training required to treat diaphragmatic disease.
Subject(s)
Humans , Benchmarking , Classification , Diaphragm , Liver , Ovarian NeoplasmsABSTRACT
En este artículo se revisa la anatomía peritoneal normal en diferentes modalidades de imágenes seccionales. Serán expuestas las definiciones y características demográficas e imaginológicas de las patologías neoplásicas primaria y secundaria que involucran el peritoneo, para la adecuada evaluación de pacientes en quienes se sospecha clínicamente patología peritoneal.
This manuscript reviews normal peritoneal anatomy as seen on different cross sectional imaging modalities. Definition, demographic and imaging features of primary and secondary neoplastic pathology involving the peritoneum are discussed.
Subject(s)
Humans , Peritoneal Neoplasms , Peritoneum , Tomography, X-Ray ComputedABSTRACT
In case of unresectable or metastatic gastric cancer, though many trials have been going, treatment results are poor yet. We report a patient with peritoneal metastasis from gastric cancer effectively treated with docetaxel and cisplatin chemotherapy. The patient was a 33 year-old man who was confirmed poorly differenciated adenocarcinoma of stomach 5 years ago. At the diagnosis, the stage of gastric cancer was T2N3M0. He underwent subtotal gastrectomy with Billoth II anastomosis and 6th cycles of postoperative adjuvant chemotherapy consisting of FAMTX. After that, there was no evidence of recurrence. Three years later, he was admitted to our hospital complaining of abdominal pain and distension. Abdominal CT revealed that recurred gastric cancer in anastomotic site with carcinomatous peritonei and multiple lymphadenopathy. He was performed chemotherapy combined with docetaxel (75 mg/m2) and cisplatin (75 mg/m2). After 3rd chemotherapy, follow up abdominal CT showed nearly complete regression of bowel loops, lymph node and ascites. After completion of 7th cycles of chemotherapy, it remained as complete response for recurred gastric cancer and he has no evidence of recurrence for over 2 years.