Introduction/Background Rates of maximal effort cytoreduction increase gradually the last decades and surgical debulking of ovarian cancer implants in the upper abdominal cavity involve excision of multiple organs including the diaphragm. In the present study, we sought to determine the factors that affect survival rates of these patients.

Methodology The study was based on a retrospective chart review of patients undergoing debulking surgery between January 2009 and December 2022. Patients were subgrouped according to the setting (primary debulking, interval debulking and secondary debulking) of the operation and site of omental metastases.

Results One hundred patients were included in the study of whom 22 undergone diaphragmatic excision as a part of the surgical debulking of diaphragmatic implants. Twenty eight patients had involvement of the pleural surface of the diaphragm (stage IV), whereas the remainder were assigned to stages IIIb and IIIc. Complete cytoreduction was achieved in 82 patients. Twenty-one patients developed moderate pleural effusion and 9 patients developed severe pleural effusion that required placement of a chest drainage. Within a median follow-up of 20 months (5–115) 32 patients experienced disease recurrence and 20 patients died from the disease. Diaphragmatic excision did not influence recurrence free and overall survival rates, compared to diaphragmatic stripping alone. Patients undergoing PDS had significantly longer PFS compared to patients undergoing IDS or secondary debulking (log-rank=.043). While graphical representation of the Kaplan Meier indicated differences in the overall survival of these patients differences did not reach statistical significance (log-rank=.199). Survival rates of patients with stage III disease did not differ compared to those with stage IV.

Conclusion Diaphragmatic surgery is an essential part of modern debulking procedures and should be ideally be performed in a PDS setting as it is accompanied by improved survival rates with acceptable rates of perioperative morbidity.

Disclosures The authors report no conflict of interest and no funding.