Transthoracic Transdiaphragmatic Resection for Liver Metastasis of Ovarian Carcinosarcoma with Invasion of Right Hemidiaphragm and Lung.

Although hepatic metastasectomy is well established for colorectal and neuroendocrine tumors, the treatment of hepatic metastases from other sites is not well defined. We present a case of ovarian carcinosarcoma with liver metastasis that invaded the right hemidiaphragm and lower lobe of right lung. En bloc transthoracic lung, right hemidiaphragm and liver resection was performed without using an abdominal incision. The patient survived nearly 2.5 years (27 months) after this surgery. Synchronous hepatic and pulmonary metastasectomies can be recommended for the metastatic tumors from the primary gynecologic malignancies. This procedure can be done with low morbidity, mortality rates and prolonges survival. Inspite of the limited experience, the choice of transthoracic synchronous pulmonary and hepatic metastasectomy should be remembered for the patients with subdiapragmatic liver and right sided lung metastasis.

Over Karsinosarkomunun, sað hemidiafragma ve akciðere invaze karaciðer metastazýnýn transtorasik transdiafragmatik rezeksiyonu

Kolorektal ve nöroendokrin tümörlerde hepatik metastazektominin klinik faydasý çok iyi tanýmlanmýþ olmasýna karþýn, diðer tümörlerinde bu uygulamanýn yeri çok net deðildir. Bu yazýda over karsinosarkomuna baðlý sað hemidiafragma ve sað akciðer alt lobunu invaze etmiþ karaciðer metastazlý bir olgu sunmaktayýz. Bu olguya abdominal giriþim uygulanmadan transtorasik olarak yaklaþýlmýþ ve sað hemidiafragma, akciðer ve karaciðer rezeksiyonu uygulanmýþtýr. Hasta bu cerrahi giriþim sonrasý ortalama 2,5 yýl (27 ay) yaþamýþtýr. Primer jinekolojik malignitelere baðlý uzak organ metastazlarýnda da, düþük morbidite ve mortalite oranlarý ve sað kalýmý uzamasý nedeniyle senkron hepatik ve pulmoner metastazektomi uygulanabilir. Bu alanda kýsýtlý tecrübeler olmasýna raðmen özellikle subdiafragmatik karaciðer ile sað akciðere olan metastazlarda, transtorasik senkron pulmoner ve hepatik metastazektomi akýlda tutulmalýdýr.