Diaphragmatic Metastasis from Endometrial Carcinoma Resected Laparo- and Thoracoscopically: A Case Report

Abstract

We report a case of diaphragmatic metastasis from endometrial carcinoma that was resected laparoscopically and thoracoscopically. A 55-year-old woman underwent multiple surgeries for endometrial carcinoma recurrence 33 months after the initial treatment. Follow-up CT revealed a low-density area in the liver, suggesting liver metastasis from the endometrial carcinoma. On referral to our department, diaphragmatic metastasis with hepatic or pulmonary invasion or liver metastasis was suspected. We planned to perform staging laparoscopy first, followed by laparoscopic partial diaphragmatic resection, partial hepatic resection, and staging thoracoscopy, depending on the intraoperative findings, and then partial lung resection if there was pulmonary invasion. Although no evidence of pulmonary invasion was detected during the surgery, liver invasion was suspected; hence, combined thoracoscopic and laparoscopic partial diaphragmatic resection and partial hepatectomy were performed. She had an uneventful postoperative course and was discharged after 4 days. Multiple lung metastases were detected 24 months postoperatively and the patient received chemotherapy. Currently, 36 months after the last surgery, the patient remains alive. We suggest that combined thoracoscopic and laparoscopic surgery for diaphragmatic tumors is a less invasive and relatively safe approach.