Introduction The diaphragm is a common site of metastasis in advanced ovarian cancer. The development of diaphragm tumor resection surgery is beneficial for achieving complete tumor cell elimination and also poses challenges to the management of perioperative complications. This study aims to explore the influencing factors and prevention and treatment strategies for complications of diaphragm surgery.

Methods This study included advanced ovarian cancer patients who underwent diaphragm tumor resection surgery at Fudan University Shanghai Cancer Center from July 2015 to June 2022. Clinical and pathological characteristics, diaphragm surgical methods, and perioperative complications were retrospectively collected.

Results A total of 396 patients with advanced ovarian cancer were included. 163 patients had perioperative complications, whereas pleural effusion (32.6%), infection (8.3%), and pneumothorax (5.3%) were the most commonly reported. Patients with longer surgery duration (>3 hours) and higher surgical difficulty (Aletti score >5) had a higher incidence of postoperative complications (p<0.01), particularly pleural effusion (p<0.01). Only 60 patients (15.2%) underwent chest tube placement overall, which is not enough to support the routine use of prophylactic chest tube placement in all patients. The incidence of postoperative pleural effusion was significantly higher in patients who underwent diaphragmatic incision surgery (47.8%) than in others(29.5%) (p=0.03).

Conclusion/Implications Pleural effusion is the most common complication of diaphragmatic surgery in ovarian cancer patients. Long surgery duration and high surgical difficulty correlated with postoperative pleural effusions. Routine placement of the prophylactic chest tube is not suitable for all patients. However, for patients who undergo diaphragmatic incision surgery, intraoperative chest tube placement should be considered.