Narrative review of liver mobilization, diaphragm peritonectomy, full-thickness diaphragm resection, and reconstruction

• Published in: Gland surgery Vol. 10; no. 3; pp. 1212 - 1217
• Main Authors: Shin, Wonkyo, Mun, Jaehee, Park, Sang-Yoon, Lim, Myong Cheol
• Format: Journal Article
• Language: English
• Published: China (Republic : 1949- ) AME Publishing Company 01.03.2021
• Subjects: Review on Ultra-Radical Surgery in Ovarian Cancer: Surgical Techniques for Gynecologic Oncologist; Ovarian cancer (OC); diaphragm; residual tumor; cytoreductive surgery
• ISSN: 2227-684X; 2227-8575
• DOI: 10.21037/gs-20-422

Epithelial ovarian cancer is the most lethal among gynecologic cancers. Despite advances in research efforts to cure this disease, the recurrence and survival rates have not significantly improved. Primary cytoreductive surgery and adjuvant chemotherapy are the standard treatment options for patients with epithelial ovarian cancer. Two randomized trials recently introduced neoadjuvant chemotherapy followed by interval cytoreductive surgery as an alternative treatment option. In any case, the size of the residual tumor after surgery is the most important prognostic factor for patients with ovarian cancer. With the improvement of surgical techniques in gynecologic oncology, cytoreductive surgery is now performed for the pelvic area and entire abdomen. Currently, surgical resectability of a mass spreading into the upper abdomen is the most important factor for achieving optimal cytoreduction. In this study, we explain the procedure of a cytoreductive surgery, involving the resection of a tumor located in the upper abdomen. We aimed to review and describe the surgical techniques involved in liver mobilization, diaphragm peritonectomy, and full-thickness diaphragm resection and reconstruction. Further, we have assessed the postoperative care involved and discussed complications that may possibly arise along with suggestions to avoid them based on the review of previous literature on the subject.