Assessment of intraoperative tube thoracostomy after diaphragmatic resection as part of debulking surgery for primary advanced-stage Müllerian cancer

• Published in: Gynecologic oncology 2013-10, Vol.131 (1), p.32-35
• Main Authors: Kato, Kazuyoshi, Tate, Shinichi, Nishikimi, Kyoko, Shozu, Makio
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Blood Transfusion; Chest tube; Chest Tubes; Diaphragm - surgery; Diaphragmatic resection; Drainage; Fallopian Tube Neoplasms - pathology; Fallopian Tube Neoplasms - surgery; Female; Hematology, Oncology and Palliative Medicine; Humans; Middle Aged; Neoplasm Staging; Obstetrics and Gynecology; Ovarian cancer; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Peritoneal Neoplasms - pathology; Peritoneal Neoplasms - surgery; Pleural effusion; Pleural Effusion - etiology; Pleural Effusion - surgery; Retrospective Studies; Thoracostomy - adverse effects
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2013.07.091

Abstract Objective The present study assessed the use of an intraoperative tube thoracostomy for patients with primary advanced-stage ovarian, fallopian tube, or peritoneal cancer who underwent a diaphragmatic resection as part of debulking surgery and to define which patients are more likely to benefit from an intraoperative tube thoracostomy. Methods All consecutive patients with stage IIIC–IV Müllerian cancer who underwent diaphragmatic resection at our institution between April 2008 and March 2013 were retrospectively reviewed. When a full-thickness resection of the diaphragm was performed and the thoracic cavity was opened, a chest tube was routinely placed during surgery. Patient-, disease-, and surgery-related data were collected from the patients' medical records. The data were evaluated with particular attention directed at pleural effusion after diaphragmatic resection. Results A total of 37 patients were included in this study. No complications associated with the intraoperative tube thoracostomy procedures occurred. An infection of the thoracic cavity occurred in one patient, following the presence of intra-abdominal abscess. The total volume of pleural drainage ranged from 88 to 2826 mL (median, 965 mL). The estimated blood loss, intraoperative blood transfusion, and area of the diaphragmatic opening were significantly associated with the total volume of pleural drainage in univariate analyses. In a multivariate analysis, the estimated blood loss was the only factor to be significantly associated with the total volume of pleural drainage. Conclusions A prophylactic tube thoracostomy might be considered if the volume of the estimated blood loss is higher than usual.