JCT  Vol.5 No.7 , June 2014
Factors Associated with Need for Drainage of Pleural Effusion after Diaphragm Surgery
Abstract: Background: Diaphragm surgery is common with advanced ovarian malignancies. The purpose of this study is to determine associated factors with the need for drainage of pleural effusion after diaphragm surgery. Methods and Materials: A retrospective chart review was undertaken in all women undergoing debulking surgery for stage IIIc/IV ovarian cancer from 2007-2009. Results: One hundred and eight patients were found to be eligible for the study, but 73 were the primary focus of this paper due to having undergone debulking surgery, including diaphragmatic surgery, from 2007-2009. All 73 had ablation with the argon beam coagulator, 7 had a full thickness resection, and 7 had extensive peritoneal peel. Five patients had preoperative effusions. Only 7 patients required chest drainage postoperatively. Pre-operative ascites correlated closely with postoperative effusion (p-value = 0.031) but not with drainage (p-value = 0.068). The mean age of patients requiring drainage was significantly older (73 years) than that of patients who did not require drainage (60 years) (p-value = 0.002). Conclusion: Older patients undergoing diaphragm surgery are more likely to require chest tube or thoracentesis due to concurrent symptoms. Pre-operative ascites correlates closely with the development of postoperative effusion after diaphragm surgery.
Cite this paper: Whynott, R. , Khurshid, N. , Nayak, S. , Manahan, K. and Geisler, J. (2014) Factors Associated with Need for Drainage of Pleural Effusion after Diaphragm Surgery. Journal of Cancer Therapy, 5, 680-684. doi: 10.4236/jct.2014.57077.

[1]   Chi, D.S., Franklin, C.C., Levine, D.A., Akselrod, F., Sabbatini, P., Jarnagin, W.R., DeMatteo, R., Poynor, E.A., AbuRustum, N.R. and Barakat, R.R. (2004) Improved Optimal Cytoreduction Rates for Stages IIIC and IV Epithelial Ovarian, Fallopian Tube, and Primary Peritoneal Cancer: A Change in Surgical Approach. Gynecologic Oncology, 94, 650-654.

[2]   Chang, S.J., Bristow, R.E. and Ryu, H.S. (2012) Impact of Complete Cytoreduction Leaving No Gross Residual Disease Associated with Radical Cytoreductive Surgical Procedures on Survival in Advanced Ovarian Cancer. Annals of Surgical Oncology, 19, 4059-4067.

[3]   Eisenkop, S.M. and Spirtos, N.M. (2001) Procedures Required to Accomplish Complete Cytoreduction of Ovarian Cancer: Is There a Correlation with “Biological Aggressiveness” and Survival? Gynecologic Oncology, 82, 435-441.

[4]   Zapardiel, I., Peiretti, M., Zanagnolo, V., Biffi, R., Bocciolone, L., Landoni, F., Aletti, G., Colombo, N. and Maggioni, A. (2011) Diaphragmatic Surgery during Primary Cytoreduction for Advanced Ovarian Cancer: Peritoneal Stripping versus Diaphragmatic Resection. International Journal of Gynecological Cancer, 21, 1698-1703.

[5]   Rafii, A., Stoeckle, E., Jean-Laurent, M., Ferron, G., Morice, P., Houvenaeghel, G., Lecuru, F., Leblanc, E. and Querleu, D. (2012) Multi-Center Evaluation of Post-Operative Morbidity and Mortality after Optimal Cytoreductive Surgery for Advanced Ovarian Cancer. PLoS ONE, 7, Article ID: e39415.

[6]   Tan, D.S., Agarwal, R. and Kaye, S.B. (2006) Mechanisms of Transcoelomic Metastasis in Ovarian Cancer. Lancet Oncology, 7, 925-934.

[7]   Griffiths, C.T. and Finkler, N. (1992) Surgery for Carcinoma of Ovary: Extrapelvic Cytoreduction. In: Coppleson, M., Ed., Gynecologic Oncology, 2nd Edition, Churchill Livingstone, London, 1325-1333.

[8]   Cliby, W., Dowdy, S., Feitoza, S., Gostout, B. and Podratz, K. (2004) Diaphragm Resection for Ovarian Cancer: Technique and Short-Term Complications. Gynecologic Oncology, 94, 655-660.

[9]   Dowdy, S.C., Loewen, R.T., Aletti, G., Feitoza, S.S. and Cliby, W. (2008) Assessment of Outcomes and Morbidity Following Diaphragmatic Peritonectomy for Women with Ovarian Carcinoma. Gynecologic Oncology, 109, 303-307.

[10]   Chi, D.S., Eisenhauer, E.L., Zivanovic, O., Sonoda, Y., Abu-Rustum, N.R., Levine, D.A., Guile, M.W., Bristow, R.E., Aghajanian, C. and Barakat, R.R. (2009) Improved Progression-Free and Overall Survival in Advanced Ovarian Cancer as a Result of a Change in Surgical Paradigm. Gynecologic Oncology, 114, 26-31.

[11]   Silver, D.F. (2004) Full-Thickness Diaphragmatic Resection with Simple and Secure Closure to Accomplish Complete Cytoreductive Surgery for Patients with Ovarian Cancer. Gynecologic Oncology, 95, 384-387.

[12]   Eisenhauer, E., Abu-Rustum, N., Sonoda, Y., Levine, D., Poynor, E., Aghajanian, C., et al. (2006) The Addition of Extensive Upper Abdominal Surgery to Achieve Optimal Cytoreduction Improves Survival in Patients with Stages IIIC-IV Epithelial Ovarian Cancer. Gynecologic Oncology, 103, 1083-1090.

[13]   Montz, F., Schlaerth, J. and Berek, J. (1989) Resection of Diaphragmatic Peritoneum and Muscle: Role in Cytoreductive Surgery of Ovarian Cancer. Gynecologic Oncology, 35, 338-340.

[14]   Tsolakidis, D., Amant, F., Van Gorp, T., Leunen, K., Neven, P. and Vergote, I. (2010) Diaphragmatic Surgery during Primary Debulking in 89 Patients with Stage IIIB-IV Epithelial Ovarian Cancer. Gynecologic Oncology, 116, 489-496.

[15]   Fanfani, F., Fagotti, A., Gallotta, V., Ercoli, A., Pacelli, F., Costantini, B., Vizzielli, G., Margariti, P.A., Garganese, G. and Scambia, G. (2010) Upper Abdominal Surgery in Advanced and Recurrent Ovarian Cancer: Role of Diaphragmatic Surgery. Gynecologic Oncology, 116, 497-501.

[16]   Eisenhauer, E.L., D’Angelica, M.I., Abu-Rustum, N.R., Sonoda, Y., Jarnagin, W.R., Barakat, R.R. and Chi, D.S. (2006) Incidence and Management of Pleural Effusions after Diaphragm Peritonectomy or Resection for Advanced Mullerian Cancer. Gynecologic Oncology, 103, 871-877.

[17]   Aletti, G., Dowdy, S., Podratz, K. and Cliby, W. (2006) Surgical Treatment of Diaphragm Disease Correlates with Improved Survival in Optimally Debulked Advanced Stage Ovarian Cancer. Gynecologic Oncology, 100, 283-287.

[18]   Vergote, I., Marquette, S., Amant, F., Barteloot, P. and Neven, P. (2005) Port-Site Metastases after Open Laparoscopy: A Study in 173 Patients with Advanced Ovarian Carcinoma. International Journal of Gynecological Cancer, 15, 776-779.

[19]   Chereau, E., Ballester, M., Selle, F., Cortez, A., Pomel, C. and Darai, E. (2009) Pulmonary Morbidity of Diaphragmatic Surgery for Stage III/IV Ovarian Cancer. British Journal of Obstetrics and Gynaecology, 116, 1062-1068.

[20]   Seneff, M.G., Corwin, R.W., Gold, L.H. and Irwin, R.S. (1986) Complications Associated with Thoracocentesis. Chest, 90, 97-100.

[21]   Tsolakidis, D., Amant, F., Leunen, K., Cadron, I., Neven, P. and Vergote, I. (2011) Comparison of Diaphragmatic Surgery at Primary or Interval Debulking in Advanced Ovarian Carcinoma: An Analysis of 163 Patients. European Journal of Cancer, 47, 191-198.