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Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma: A Systematic Review and Meta-analysis
  1. Giorgio Bogani, MD*,
  2. Antonino Ditto, MD*,
  3. Fabio Martinelli, MD*,
  4. Domenica Lorusso, MD*,
  5. Valentina Chiappa, MD*,
  6. Cristina Donfrancesco, MD*,
  7. Violante Di Donato, MD*,
  8. Alice Indini, MD*,
  9. Giovanni Aletti, MD and
  10. Francesco Raspagliesi, MD*
  1. *Department of Gynecologic Oncology, IRCCS National Cancer Institute; and
  2. Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy.
  1. Address correspondence and reprint requests to Giorgio Bogani, MD, IRCCS Foundation, National Cancer Institute, Via Venezian 1, 20133 Milan, Italy. E-mail:


Objective Optimal cytoreduction is one the main factors improving survival outcomes in patients affected by ovarian cancer (OC). It is estimated that approximately 40% of OC patients have gross disease located on the diaphragm. However, no mature data evaluating outcomes of surgical techniques for the management of diaphragmatic carcinosis exist. In the present study, we aimed to estimate surgery-related morbidity of different surgical techniques for diaphragmatic cytoreduction in advanced or recurrent OC.

Methods PubMed (MEDLINE), Web of Science, and databases were searched for records estimating outcomes of diaphragmatic peritoneal stripping (DPS) or diaphragmatic full-thickness resection (DFTR) for OC. The meta-analysis was performed using the Cochrane Review software.

Results For the final analysis, 5 articles were available, including 272 patients. Diaphragmatic peritoneal stripping and DFTR were performed in 197 patients (72%) and 75 patients (28%), respectively. Pooled analysis suggested that the estimated pleural effusion rate was 43% and 51% after DPS and DFTR, respectively. The need for pleural punctures or chest tube placement was 4% and 9% after DPS and DFTR, respectively. The rate of postoperative pneumothorax (4% vs 9%; odds ratio, 0.31; 95% confidence interval, 0.05–2.08) and subdiaphragmatic abscess (3% vs 3%; odds ratio, 0.45; 95% confidence interval, 0.09–2.31) were similar after the execution of DPS and DFTR.

Conclusions Diaphragmatic surgery is a crucial step during cytoreduction for advanced or recurrent OC. Obviously, the choice to perform DPS or DFTR depends on the infiltration of the diaphragmatic muscle or not. Both the procedures are associated with a low pulmonary complication and chest tube placement rates.

  • Ovarian cancer
  • Diaphragmatic surgery
  • Pulmonary complications
  • Morbidity
  • Survival

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  • The study was conducted in Milan, Italy.

  • The authors declare no conflicts of interest.