Diaphragmatic Surgery in Advanced Ovarian, Tubal and Peritoneal Cancer. A 7-Year Retrospective Analysis of the Tumor Bank Ovarian Cancer Network

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.