Objectives This study was designed to validate the feasibility, effect on the new International Federation of Gynecology and Obstetrics (FIGO) staging, and surgical indications of transdiaphragmatic thoracic exploration (TDTE) without the use of thoracoscopy.

Methods Patients with ovarian cancer who underwent TDTE after either diaphragm peritonectomy or full-thickness diaphragm resection between January 2009 and March 2014 were selected for our study.

Results Twenty-two patients with a median age of 53 years and a median level of CA125 at 1134 U/mL before operation were included in our study. We found that 14/22 (63.6%) patients have pleural metastases and were diagnosed as FIGO stage IVB due to the TDTE process. Three patients had TDTE-related complications after surgery. We also found that 7 cases were performed with TDTE unintentionally, whereas intentional TDTE was performed in 15 patients including 5 cases with untapped pleural effusion, 4 with full-depth diaphragmatic invasion, 1 with positive pleural disease on computed tomography, and 5 with none of the reasons previously mentioned.

Conclusions Transdiaphragmatic thoracic exploration is a feasible procedure. The FIGO staging may be adjusted after TDTE. The surgical indications for TDTE should consider an untapped pleural effusion and full-depth diaphragmatic invasion.