Analysis Of Postoperative Complications And Prognostic Factors Of Advanced Ovarian Cancer With Diaphragmatic Surgery

Objective: To investigate the postoperative complications and prognostic factors of diaphragmatic surgery for advanced ovarian cancer.Methods: Retrospective in November 2013 to November 2018,a total of 5years in guangxi medical university affiliated tumor hospital of 54 cases of Ovarian malignant tumor patients in the surgical treatment of the clinical data of diaphragmatic myopathy focal resection: general data,auxiliary examination,surgical treatment,intraoperative and postoperative complications,postoperative follow-up survival and so on,and carries on the collection and analysis.Univariate logistic regression analysis was performed.Kaplan-meier method was used to estimate the median and total survival of patients,and the survival curve was drawn.Log-rank method was used to test the difference in survival,and COX proportional risk model was used to test independent prognostic factors.P < 0.05 indicates a significant difference.Results: Fifty-four patients met the criteria,including 50 years old(21-80 years old)and 45 patients with preoperative ascites.Preoperative pleural effusion was found in 20 patients,including 15 on both sides,2 on the right side and 3 on The left side.All the 54 patients underwent tumor cell destruction includingdiaphragmatic surgery,including 36 cases of diaphragmatic dissection(dissection of peritoneum and mass on the surface of diaphragm)and 18 cases of diaphragmatic dissection(dissection of peritoneum and muscle layer on the surface of diaphragm).There were no statistically significant differences in intraoperative conditions and complications between phrenectomy and phrenectomy.Among the 43 patients who achieved satisfactory surgical results with tumor cell reduction(R1: residual lesions less than 1cm),16 patients achieved complete tumor cell reduction(R0: no residual lesions with naked eyes).Postoperative pleural effusion occurred in 8 patients,5 of whom underwent pleural puncture and drainage,and the remaining 3 patients disappeared after general symptomatic treatment and postoperative chemotherapy.Postoperative pleural effusion is the main complication of phrenic myopathy focus resection,intraoperative blood loss is an independent risk factor affecting postoperative pleural effusion,the larger the blood loss,the more prone to postoperative pleural effusion.Preoperative albumin level and intraoperative blood transfusion volume were negatively correlated with postoperative pleural effusion,which was the protective factor of postoperative pleural effusion.The larger intraoperative blood transfusion volume was,the higher preoperative plasma albumin level was,and the less prone to postoperative pleural effusion.The mean survival time of 54 patients with advanced ovarian cancer who underwent phrenic metastasis resection was 39.9months and the median survival time was 40 months.Among them,the average survival time of the patients with no visual residual was 43.7 months,the average survival time of the patients with surgical residual lesions less than 1cm was 39.9 months,and the average survival time of the patients with unsatisfactory tumor cell reduction was 29.7 months.The operative mode,intraoperative chemotherapy and residual lesions were correlated with the prognosis of the patients.Conclusion: Diaphragmatic surgery is very necessary in the operation of tumor cell inactivation of advanced ovarian malignant tumor,which can improve the complete resection rate of tumor and affect the achievement rate of ideal tumor cell inactivation operation to improve the prognosis of patients.Postoperative complications cannot be completely avoided,and one or more complications may occur,most of which are pleural effusion.For patients with compression symptoms caused by massive pleural effusion,pleural puncture and drainage are feasible.Preoperative plasma albumin,intraoperative blood loss and intraoperative blood transfusion were the influencing factors of postoperative pleural effusion.The size of surgical residual lesion,intraoperative abdominal chemotherapy,and diaphragm surgery were associated with the prognosis of patients.Excision of metastatic lesions as far as possible,combined with intraoperative intraperitoneal chemotherapy,can improve the prognosis of patients.For diaphragmatic metastases with lesions larger than 4cm,diaphragmatic resection is recommended to improve the prognosis.