Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3700–3705 | Cite as

A Review of Thoracic and Mediastinal Cytoreductive Techniques in Advanced Ovarian Cancer: Extending the Boundaries

  • Sara Nasser
  • Mara Kyrgiou
  • Jonathan Krell
  • Dimitrios Haidopoulos
  • Robert Bristow
  • Christina Fotopoulou
Gynecologic Oncology


The aim of this study was to review the surgical and clinical outcomes of intrathoracic and mediastinal surgical cytoreduction in stage IV epithelial ovarian cancer (EOC). Relevant articles were identified from MEDLINE and EMBASE. Only analyses or reports that described actual intrathoracic cytoreduction via pleurectomy and/or resection of cardiophrenic/mediastinal lymph nodes were included. Imaging articles that merely described thoracic tumor patterns were excluded. A total of nine studies were identified, the oldest originating in 2007. Procedures described were transdiaphragmatic resection of cardiophrenic lymph nodes and pleural disease (n = 5) and video-assisted thoracoscopic and mediastinal tumorectomies including pleurectomy (n = 4). The number of operated patients ranged between 1 and 30 with complete cytoreduction rates ranging between 68 and 100%. No surgical deaths directly related to the thoracic cytoreduction were reported and only one patient (1/30) experienced a postoperative complication in terms of a pneumothorax. None of the studies presented a direct comparison of survival to patients with thoracic disease who did not undergo thoracic cytoreduction, and therefore the survival benefit of thoracic cytoreduction could not be quantified. In conclusion, thoracic cytoreduction in advanced EOC seems feasible and with acceptable morbidity while offering a better understanding of the extent of disease and hence allowing the tailoring of intraabdominal resections. Nevertheless, its direct impact on patients’ survival by a potential overruling of a more adverse tumor biology remains to be established in larger-scale prospective and ideally randomized trials.



The authors declare that there are no conflicts of interest.


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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Sara Nasser
    • 1
  • Mara Kyrgiou
    • 1
    • 2
  • Jonathan Krell
    • 1
    • 2
  • Dimitrios Haidopoulos
    • 3
  • Robert Bristow
    • 4
  • Christina Fotopoulou
    • 1
    • 2
  1. 1.NHS Trust, West London Gynecological Cancer CentreImperial CollegeLondonUK
  2. 2.Department of Surgery and CancerImperial College LondonLondonUK
  3. 3.Department of Obstetrics and Gynecology, Alexandra HospitalUniversity of AthensAthensGreece
  4. 4.Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Irvine – School of MedicineUniversity of CaliforniaIrvineUSA

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