The benefit of video-assisted thoracoscopic surgery before planned abdominal exploration in patients with suspected advanced ovarian cancer and moderate to large pleural effusions Journal Article

  

Authors:	Chi, D. S.; Abu-Rustum, N. R.; Sonoda, Y.; Chen, S. W. W.; Flores, R. M.; Downey, R.; Aghajanian, C.; Barakat, R. R.
Article Title:	The benefit of video-assisted thoracoscopic surgery before planned abdominal exploration in patients with suspected advanced ovarian cancer and moderate to large pleural effusions
Abstract:	Objective. To analyze the findings and impact on the management of video-assisted thoracoscopic surgery (VATS) before planned abdominal exploration in patients with suspected advanced ovarian cancer and moderate to large pleural effusions. Methods. We reviewed the charts of all patients with suspected advanced ovarian cancer and moderate to large pleural effusions who underwent VATS from 10/01 to 7/03. VATS was performed under double lumen endotracheal anesthesia. A 2-cm chest wall incision was made in the fifth intercostal space on the side of the effusion. The thoracoscope was introduced and biopsies of suspicious lesions were performed through the single incision. After VATS, all patients had a chest tube placed through the incision, and those with malignant effusions underwent talc pleurodesis either intraoperatively or postoperatively. Results. Twelve patients underwent VATS during the study period. Median operative time for VATS was 31 min (range: 20-49 min) with no complications attributable to the procedure. The median amount of pleural fluid drained was 1000 ml (range: 500-2000 ml). Solid, pleural-based tumor was found in six cases (50%), with nodules >1 cm noted in four patients (33%) and nodules <1 cm noted in two patients (17%). Of the six cases with no grossly visible pleural tumor, the pleural fluid was positive for malignant cells in two patients (17%) and negative in four patients (33%). Further initial patient management included the following: laparotomy with optimal cytoreduction, 6 (50%); diagnostic laparoscopy, 3 (25%); and no abdominal exploration, 3 (25%). Final diagnosis of primary disease site was as follows: ovary, 9 (75%); fallopian tube, 1 (8%); endometrium, 1 (8%); and lymphoma, 1 (8%). Based on the findings during VATS, laparotomy and attempted cytoreduction were avoided in four patients (33%), and the cytoreductive procedure was modified in one patient (8%). Conclusion. Fifty percent of patients with suspected advanced ovarian cancer and moderate to large pleural effusions who underwent VATS had solid pleural-based tumor identified, and in 33% of cases the tumor nodules were >1 cm in diameter. VATS should be considered in these cases to delineate the extent of disease, treat the effusion, and to potentially select patients for either intrathoracic cytoreduction or a neoadjuvant chemotherapy approach. © 2004 Elsevier Inc. All rights reserved.
Keywords:	adult; clinical article; controlled study; human tissue; aged; middle aged; surgical technique; retrospective studies; review; advanced cancer; treatment planning; laparoscopic surgery; ovarian neoplasms; ovary cancer; tumor biopsy; postoperative complication; ovary; abdomen; cancer cell; operation duration; lymphoma; endoscopic surgery; pleura effusion; pleura fluid; pleural effusion, malignant; advanced ovarian cancer; thoracic surgery, video-assisted; thorax wall; vats; thoracoscopy; endometrium; uterine tube; pleurodesis; talc; humans; human; female; priority journal; moderate to large pleural effusions; thoracoscope
Journal Title:	Gynecologic Oncology
Volume:	94
Issue:	2
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2004-08-01
Start Page:	307
End Page:	311
Language:	English
DOI:	10.1016/j.ygyno.2004.04.027
PROVIDER:	scopus
PUBMED:	15297166
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-3543149537&partnerID=40&md5=2c03bddff51f39fcf651f7ef151e65e9
Notes:	Gynecol. Oncol. -- Cited By (since 1996):24 -- Export Date: 16 June 2014 -- CODEN: GYNOA -- Source: Scopus

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