title: Diaphragmatic surgery during primary cytoreduction for advanced ovarian cancer: peritoneal stripping versus diaphragmatic resection.
abstract: 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.
authors.affiliation: Gynecologic Oncology Department, European Institute of Oncology, Milan, Italy. ignaciozapardiel@hotmail.com
authors.forename: Ignacio
authors.initials: I
authors.lastname: Zapardiel
authors.forename: Michele
authors.initials: M
authors.lastname: Peiretti
authors.forename: Vanna
authors.initials: V
authors.lastname: Zanagnolo
authors.forename: Roberto
authors.initials: R
authors.lastname: Biffi
authors.forename: Luca
authors.initials: L
authors.lastname: Bocciolone
authors.forename: Fabio
authors.initials: F
authors.lastname: Landoni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Aletti
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Colombo
authors.forename: Angelo
authors.initials: A
authors.lastname: Maggioni
mesh_terms: D003964:Diaphragm / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D010529:Peritoneal Cavity / Q000601:surgery