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Diaphragmatic Surgery During Primary Cytoreduction for Advanced Ovarian Cancer: Peritoneal Stripping Versus Diaphragmatic Resection
  1. Ignacio Zapardiel, MD, PhD,
  2. Michele Peiretti, MD, PhD,
  3. Vanna Zanagnolo, MD,
  4. Roberto Biffi, MD,
  5. Luca Bocciolone, MD,
  6. Fabio Landoni, MD,
  7. Giovanni Aletti, MD,
  8. Nicoletta Colombo, PhD and
  9. Angelo Maggioni, MD
  1. Gynecologic Oncology Department, European Institute of Oncology, Milan, Italy.
  1. Address correspondence and reprint requests to Ignacio Zapardiel, MD, PhD, Gynecologic Oncology Department, European Institute of Oncology, Via Ripamonti 435, Milan, Italy. E-mail: ignaciozapardiel{at}


Background Standard approach for medically stable advanced ovarian cancer patients should be primary cytoreduction following platinum-based chemotherapy. The aim of surgical effort should be the complete removal of all visible disease. Our objective was to compare perioperative features, postoperative complications, and secondarily oncological outcomes of patients who underwent diaphragmatic stripping with those who underwent diaphragmatic resection for advanced ovarian cancer.

Methods One hundred twelve cases were identified, among them 79 underwent diaphragmatic stripping and 33 underwent diaphragmatic full-thickness resection. Data collected included patients’ age, all perioperative details and pathological findings, International Federation of Gynecology and Obstetrics stage, adjuvant therapy, and follow-up data.

Results Larger residual tumors (mean, 5.1 vs 1.6 mm, respectively; P < 0.01) but shorter operating time (25 minutes shorter operative time, P = 0.07) were observed in the stripping group. Higher postoperative pleural effusions rates (63.6% vs 37.9%, P = 0.01), but no differences in the remaining complications, were observed in the resection group. After a mean of 31 months of follow-up, disease-free survival rates were 27.8% in the stripping group and 39.4% in the resection group (P = 0.04). No significant differences were observed for overall survival.

Conclusions Diaphragmatic surgery at the time of primary cytoreductive surgery for advanced ovarian cancer may contribute to the achievement of complete cytoreduction with low perioperative complication rate; full-thickness resection is preferable if peritoneum stripping will not achieve a complete removal of the disease.

  • Diaphragmatic surgery
  • Diaphragmatic stripping
  • Primary cytoreduction
  • Ovarian cancer
  • Diaphragmatic resection

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  • The authors have no conflicts of interest to declare.