title: Diaphragmatic Surgery in Advanced Ovarian, Tubal and Peritoneal Cancer. A 7-Year Retrospective Analysis of the Tumor Bank Ovarian Cancer Network.
abstract: This study aimed to analyze diaphragmatic interventions and their complications in primary cytoreductive surgery (PCS) and to study their impact on attaining complete tumor resection (CTR) in advanced ovarian cancer (AOC), which is purportedly reflected in better disease-free and overall survival.
  
  
  
  The study's collective consisted of 536 consecutive patients presenting a first diagnosis of AOC who underwent PCS between 2007 and 2013 at the Charité Medical University, Berlin. A total of 268 patients underwent diaphragmatic interventions, while 268 did not undergo any kind of diaphragmatic surgery.
  
  
  
  Diaphragmatic interventions were indicated in 50% of cases with AOC. The surgical interventions varied between diaphragmatic partial resection (44.8%), stripping (53%) and only infrared coagulation (2.2%). The postoperative complication rate was higher in the diaphragm-intervention group in comparison to the group without any diaphragmatic intervention (49.6% vs. 38.8%), but most postoperative complications were not directly related to the diaphragmatic intervention itself but to the statically significant increase of other radical surgical procedures in this group. Pleura effusion was the only increased complication with a direct correlation with diaphragmatic surgery (25.4% vs. 14.2%). Preoperatively apparent stage IV (pleura effusion) disease, very high cancer antigen-125 value, serous papillary tumors and the presence of massive ascites (>500 ml) were statistically significant predictors of the need for diaphragmatic surgery in order to achieve CTR.
  
  
  
  Our current findings consider diaphragmatic surgery as being acceptable, feasible and in many cases as an essential intervention to achieve CTR or suboptimal debulking with an acceptable complication rate.
authors.affiliation: Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany Mustafa-Zelal.Muallem@charite.de.
authors.forename: Mustafa Zelal
authors.initials: MZ
authors.lastname: Muallem
authors.affiliation: Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany.
authors.forename: Jumana
authors.initials: J
authors.lastname: Almuheimid
authors.affiliation: Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Richter
authors.affiliation: Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany Tumor Bank Ovarian Cancer Network, Berlin, Germany.
authors.forename: Elena Ioana
authors.initials: EI
authors.lastname: Braicu
authors.affiliation: Tumor Bank Ovarian Cancer Network, Berlin, Germany.
authors.forename: Suzan
authors.initials: S
authors.lastname: Osman
authors.affiliation: Department of Gynecology, Campus Virchow-Klinikum, Charité Medical University, Berlin, Germany.
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects; D003964:Diaphragm / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D010996:Pleural Effusion / Q000473:pathology; D011183:Postoperative Complications
chemical_list: D018394:CA-125 Antigen
keywords: Advanced ovarian cancer; debulking; diaphragmatic surgery