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Roberto Tozzi,Hooman Soleymani Majd,Riccardo Garruto Campanile,Federico Ferrari 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5
Objective: To describe the surgical technique and evaluate the safety, feasibility and efficacyof laparoscopic diaphragmatic peritonectomy during Visceral-Peritoneal Debulking (VPD) inpatients with stage IIIC-IV ovarian cancer (OC). Methods: This report is part of a Service Evaluation Protocol (Trust number 3267) onlaparoscopy in patients with OC following neo-adjuvant chemotherapy. Between April 2015and November 2017, all patients underwent to exploratory laparoscopy and a selected courtwas offered laparoscopic VPD. Laparoscopic diaphragmatic surgery was considered if therewas no full thickness involvement. Primary endpoints of this part of the study were the safety,feasibility and efficacy of laparoscopic diaphragmatic peritonectomy. We report the surgicaltechnique and outcomes. Results: Ninety-six patients underwent diaphragmatic surgery during the study period. Fiftypatients (52.1%) had intra-operative exclusion criteria and/or full thickness diaphragmaticresection, 46 (47.9%) had peritonectomy and were included in the study. Laparoscopicdiaphragmatic peritonectomy was performed in 21 patients (45.4%, group 1), while in 25patients (54.6%, group 2) laparotomy was necessary. Extent of disease and complexityof surgery were similar. Reasons for conversions were disease coalescing the liver to thediaphragm preventing safe mobilization (22 patients) and accidental pleural opening (3patients). Overall, intra- and post-operative morbidity was lower in group 1 and pulmonaryspecific morbidity was very low. Conclusion: Diaphragmatic peritonectomy can be safely accomplished by laparoscopy inalmost half of the patients with OC whose disease is limited to the diaphragmatic peritoneum.
Sarah Louise Smyth,Hooman Soleymani Majd 대한산부인과학회 2023 Obstetrics & Gynecology Science Vol.66 No.5
Objective We present an educational technique for the safe completion of complete cytoreduction of diaphragmatic disease for the management of advanced ovarian malignancy. Methods We demonstrated these steps with attention to anatomical landmarks and surgical approaches, considering intraoperative and postoperative morbidity and mortality. Results We present the case of a 49-year-old female patient diagnosed with suspected stage 3C ovarian malignancy following diagnostic laparoscopy. We demonstrate the surgical application of the Pringle manoeuvre, type 3 liver mobilisation, and full-thickness diaphragmatic resection. This was completed with a primary closure technique, with integrity ensured through the performance of an air test and Valsalva manoeuvre. Final histology confirmed a serous borderline tumour with invasive implants within a port site nodule (stage 4A). Conclusion This technique affirms the essential skills in gynaecological oncology training and details a challenging case requiring advanced surgical skills and knowledge, with specific consideration for intraoperative multidisciplinary decision-making.
Roberto Tozzi,Federico Ferrari,Joost Nieuwstad,Riccardo Garruto Campanile,Hooman Soleymani Majd 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.2
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.
Roberto Tozzi,Jvan Casarin,Ahmet Baysal,Gaetano Valenti,Yakup Kilic,Hooman Soleymani Majd,Matteo Morotti 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.2
Objective: To assess the morbidity associate with rectosigmoid resection (RSR) in patients with stage IIIC–IV ovarian cancer (OC) undergone primary debulking surgery (PDS) vs. interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT). Methods: From the Oxford Advanced OC database, we retrieved all patients who underwent surgery between January 2009 and July 2016 and included all patients who underwent RSR. We compared the rates of overall related and not-related morbidity and bowel diversion in patients undergone RSR during PDS vs. IDS. Results: Three hundred and seventy-one patients underwent surgery: 126 in PDS group and 245 in IDS group. Fifty-two patients in the PDS group (41.3%) and 65 patients in IDS group (26.5%) underwent RSR (p<0.001). Overall not related morbidity rate was 37.5% and 28.6%, p=0.625. Bowel specific complications affected 16.3% vs. 11.1% of the patients (p=0.577). IDS group had higher rate of bowel diversion compared with PDS (46.0% vs. 26.5%, p=0.048). Conclusion: NACT was associated to an overall reduced rate of RSR compared to IDS. No differences in overall related and not-related complications in patients requiring RSR were seen between the 2 groups. Patients in the IDS group had a significantly higher rate of bowel diversion.