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Diaphragmatic Peritonectomy and Full-Thickness Resection in CRS/HIPEC May Allow Higher Completeness of Cytoreduction Rates with a Low Rate of Respiratory Complications

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery (CRS) provides a survival benefit when achieved without residual disease. As diaphragm is frequently affected in peritoneal malignancies, complete cytoreduction often requires surgical techniques over the diaphragm. The purpose of the study was to assess diaphragmatic resection impact on cytoreduction completeness, morbidity and mortality compared to less aggressive diaphragmatic peritonectomy in CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) settings.

Materials and Methods

Patients with peritoneal carcinomatosis and supramesocolic disease undergoing CRS/HIPEC from 2011 to 2019 were included in a prospectively collected database. We compared patients who underwent full-thickness diaphragmatic resection (DR) and diaphragmatic peritonectomy (DP). Epidemiological and clinical data, morbidity, and mortality within 90 days of surgery were documented.

Results

232 patients were initially selected. Inclusion criteria were met by 88 procedures. DR was performed on 32 patients and DP on 56. Number of resected organs was 5.21 in the DR cohort vs. 3.57 in the DP cohort (p<0.0001). Rate of Peritoneal Cancer Index (PCI) score >14 was higher in the DR group (75%) than in the DP group (50.9%) (p=0.027). Tumor invasion of diaphragmatic muscle after DR was confirmed in 89.3% patients. Postoperative pleural effusion was observed in 28 patients (50%) in the DP group and in 17 (53.1%) in the DR group.

Conclusions

CRS/HIPEC requires specific surgical techniques over the diaphragm to achieve complete cytoreduction. As diaphragmatic muscle invasion is frequent, full-thickness resection may allow a cytoreduction completeness increase without an increased morbidity. Pleural drains are not systematically required as these procedures show low incidence of major respiratory complications.

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Authors and Affiliations

  1. General and Digestive Surgery Department, University Hospital Son Espases, Palma De Mallorca, Spain

    Andrea Craus-Miguel MD, Juan José Segura-Sampedro MD, PhD, Xavier González-Argenté MD, PhD & Rafael Morales-Soriano MD, PhD

  2. Health Research Institute of Balearic Islands, Palma De Mallorca, Spain

    Andrea Craus-Miguel MD, Juan José Segura-Sampedro MD, PhD, Xavier González-Argenté MD, PhD & Rafael Morales-Soriano MD, PhD

  3. School of Medicine, University of Balearic Islands, Palma De Mallorca, Spain

    Juan José Segura-Sampedro MD, PhD & Xavier González-Argenté MD, PhD

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  1. Andrea Craus-Miguel MD
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  2. Juan José Segura-Sampedro MD, PhD
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  3. Xavier González-Argenté MD, PhD
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Correspondence to Juan José Segura-Sampedro MD, PhD.

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Andrea Craus-Miguel, Juan José Segura-Sampedro, Xavier González-Argenté, and Rafael Morales-Soriano have no disclosures to declare.

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Craus-Miguel, A., Segura-Sampedro, J.J., González-Argenté, X. et al. Diaphragmatic Peritonectomy and Full-Thickness Resection in CRS/HIPEC May Allow Higher Completeness of Cytoreduction Rates with a Low Rate of Respiratory Complications. Ann Surg Oncol 28, 4676–4682 (2021). https://doi.org/10.1245/s10434-020-09505-3

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