The impact of video-assisted thoracic surgery (VATS) in patients with suspected advanced ovarian malignancies and pleural effusions Journal Article

  

Authors:	Juretzka, M. M.; Abu-Rustum, N. R.; Sonoda, Y.; Downey, R. J.; Flores, R. M.; Park, B. J.; Hensley, M. L.; Barakat, R. R.; Chi, D. S.
Article Title:	The impact of video-assisted thoracic surgery (VATS) in patients with suspected advanced ovarian malignancies and pleural effusions
Abstract:	Objectives: We previously reported our initial experience of patients with suspected advanced ovarian cancer and moderate to large pleural effusions who underwent video-assessed thoracic surgery (VATS) before planned abdominal exploration. The objective of this study was to report the surgical findings and management of patients who underwent VATS in an update of our experience. Methods: We performed a retrospective review of all patients with suspected advanced ovarian cancer and moderate to large pleural effusions who underwent VATS for assessment of extent of intrathoracic disease at our institution between 6/01 and 8/05. Results: Twenty-three patients with a median age of 61 years (range, 36-79) were identified. VATS was performed for right-sided effusions in 17 patients (74%), and a median of 1350 ml (400-3700 ml) of pleural fluid was drained. VATS demonstrated macroscopic disease in 15 (65%) patients, with nodules > 1 cm in 11/15 (73%), and nodules < 1 cm in 4/15 (27%). Macroscopic intrathoracic disease was found in 4/10 (40%) patients with negative cytology. Intrathoracic cytoreduction was performed in 3/11 patients (27%) with intrathoracic disease > 1 cm. After VATS, 12/23 patients (52%) underwent primary surgical management, with cytoreduction to ≤ 1 cm achieved in 11/12 patients (92%). The other eleven patients received primary chemotherapy after undergoing diagnostic laparoscopy alone (4/11) or no further abdominal exploration (7/11). Nine of these patients proceeded to interval cytoreduction, while 2 had pathology demonstrating upper gastrointestinal and lymphoma primaries at the time of VATS. Final diagnosis of primary site of disease included: ovary, 14 (61%); endometrial, 2 (9%); dual ovarian/endometrial primaries, 1 (4%); fallopian tube, 1 (4%); primary peritoneal, 1 (4%); other, 4 (17%). Overall, findings at VATS altered primary surgical management in 11/23 (48%) patients. Conclusions: Sixty-five percent of patients with suspected advanced ovarian cancer and moderate to large pleural effusions had gross intrathoracic disease identified at VATS, with the majority (11/15, 73%) having disease > 1 cm in diameter. Use of VATS allows for assessment of intrathoracic disease and may help identify candidates for primary cytoreductive surgery and possible intrathoracic cytoreduction versus neoadjuvant chemotherapy. © 2007.
Keywords:	adult; clinical article; aged; middle aged; retrospective studies; cancer localization; advanced cancer; cancer patient; laparoscopy; endometrium cancer; laparotomy; cytoreductive surgery; ovarian neoplasms; ovary cancer; peritoneum cancer; retrospective study; medical assessment; cancer size; endoscopic surgery; pleura effusion; age distribution; ca 125 antigen; pleural effusion, malignant; uterine tube carcinoma; advanced ovarian cancer; thorax surgery; thoracic surgery, video-assisted; thorax drainage; cytopathology; sample size; gastrointestinal tumor; pleural effusion; video-assisted thoracic surgery
Journal Title:	Gynecologic Oncology
Volume:	104
Issue:	3
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2007-03-01
Start Page:	670
End Page:	674
Language:	English
DOI:	10.1016/j.ygyno.2006.10.010
PUBMED:	17150248
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-33846927770&partnerID=40&md5=bb96ef2164ffce248fd7084a6c103330
Notes:	--- - "Cited By (since 1996): 20" - "Export Date: 17 November 2011" - "CODEN: GYNOA" - "Source: Scopus"

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