Article Text

Download PDFPDF

Diaphragmatic and pericardiac ovarian cancer recurrence removal and mesh reconstruction
  1. Agnieszka Rychlik,
  2. Maria Bedyńska and
  3. Piotr Hevelke
    1. Department of Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
    1. Correspondence to Dr Maria Bedyńska, Gynecologic Oncology, Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology Warsaw, Warszawa, Poland; Maria.Bedynska{at}pib-nio.pl

    Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Ovarian cancer recurrence is a challenging clinical situation. Systemic treatment has been the standard of care in this group of patients; however, its survival benefit remains unclear. Since the publication of the DESKTOP III trial, cytoreductive surgery has also been considered for selected patients with ovarian cancer who relapse.1 In this study, cytoreductive surgery followed by chemotherapy resulted in longer overall survival than chemotherapy alone.

    We present the case of a BRCA1-mutated patient with a single site central diaphragmatic and pericardiac recurrence of high-grade serous ovarian cancer. The patient fulfilled a predictive score (Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) score) as defined by the DESKTOP I trial2 and qualified for secondary cytoreductive surgery.

    The single site recurrence infiltrated the full thickness of the diaphragm, the Glisson capsule, and the pericardium. After a radical resection, the defect of the pericardium was sutured directly with a PDS 3–0 running suture. In case of a large defect, the pericardium may be replaced by an absorbable or non-absorbable synthetic mesh such as impermeable expanded polytetrafluoroethylene (Gore-Tex) or permeable polypropylene mesh.3 In the case of diaphragmatic reconstruction, more costly biologic meshes were also tested including acellular porcine collagen, acellular human dermis, and bovine pericardium. The mesh should be tailor cut without any tension and sutured with interrupted non-absorbable sutures.3

    In Video 1, reconstruction of the defect of the diaphragm with 2 mm Gore Dual mesh is shown. This material has two different surfaces. The smooth layer minimizes the adhesions between the lung and the reconstructed diaphragm, which is crucial for appropriate pulmonary function, and the rough side favors the host cellular ingrowth and prevents the development of a seroma, which is considered relevant for avoiding the most severe complication—namely, displacement of the mesh.4

    Video 1 - Diaphragmatic and pericardiac ovarian cancer recurrence removal and mesh reconstruction-case presentation and surgical technique.

    The early postoperative period of the patient was uneventful. After the histopathological confirmation of a recurrence of high-grade serous ovarian carcinoma, second line platinum-based chemotherapy was indicated. A CT scan performed 7 weeks after the procedure showed no signs of dislocation of the mesh or any other related complications.

    Data availability statement

    All data relevant to the study are included in the article.

    Ethics statements

    Patient consent for publication

    References

    Footnotes

    • Contributors AR: Concept, video and manuscript editing. PH: Review, video editing. MB: Video recording, review. AR is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.