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Abstract
Introduction/Background There is high incidence of diaphragm involvement in patients with stage IIIC high grade serous ovarian cancer. We evaluated the use of the Makuuchi incision and Thompson retractor system in patients with stage IIIC high-grade serous ovarian carcinoma with diaphragmatic metastases to facilitate liver mobilization and access to the diaphragmatic domes.
Methodology A total of 110 patients with stage IIIC high-grade serous ovarian cancer underwent cytoreductive surgery with supra and infra-umbilical incisions, and 12 of them were operated through the Makuuchi incision using a Thompson retractor system. R0 resection rates were calculated for Makuuchi incision applied group and non-applied group. Complication rates, patients discomfort, analgesic need were also recorded as the secondary outcome parameters.
Results The rate of R0 debulking was achieved 95% of the Makuuchi group and 60% in the remaining subjects (p<0.05). An optimal surgical field exposure was obtained with Makuuchi incision. There were no major intraoperative complications such as bleeding or organ injuries. Blood transfusions were not required during surgery. There was no need to use additional analgesics during the postoperative period due to wound pain. During the early postoperative period, there were no complications associated with the incision, such as infection or wound dehiscence. There were no complaints regarding the cosmetic appearance of abdomen following the procedure. We did not observe any cases of incisional hernias.
1a. Makuuchi incision 1b. visible seeding mass before diaphragmatic peritoneal stripping; 1c. Postoperative image of surgical resection of the liver metastatic lesions
Conclusion Our results supported that Makuuchi incision facilitates diafragmatic stripping and liver mobilization in patients with stage IIIC high-grade serous ovarian carcinoma with diaphragmatic metastases.
Disclosures The Authors have no potential conflict(s) of interest to report.