Effect of Diaphragmatic Resection Versus Stripping in Advanced Ovarian Cancer: Impact on Patient Complications in a Large Retrospective Cohort Study at a Tertiary Referral Center.

Abstract

Complete cytoreductive surgery is crucial in advanced ovarian cancer (OC) treatment. Diaphragmatic surgery, including stripping (DS) and resection (DR), is often necessary for optimal cytoreduction. However, postoperative complications and the timing of adjuvant chemotherapy initiation remain critical concerns. This study evaluates the impact of DR and DS on surgical outcomes, chemotherapy timing, and survival. This retrospective, monocentric study analyzed 215 patients with International Federation of Gynecology and Obstetrics (FIGO) stage III-IV OC undergoing DS or DR between 2011 and 2023. Clinical, surgical, and survival data were collected; complications were graded using the Clavien-Dindo system. Statistical analysis included contingency and survival tests. A total of 215 patients underwent diaphragmatic surgery: 122 patients (56.7%) underwent DR and 93 (43.3%) DS. No significant differences existed between groups regarding age, body mass index (BMI), histological subtype, American Society of Anesthesiologists (ASA) score, or primary/interval debulking surgery distribution (p = 0.122). DR was more common in patients with greater peritoneal disease (p = 0.003), higher pleural involvement (p = 0.002), and longer operative times (p = 0.018). Postoperatively, DR was associated with increased thoracic complications (87.7% versus 52.7%, p < 0.001), greater oxygen supplementation needs (55.7% versus 35.5%, p = 0.003), and elevated liver enzymes. However, no significant differences emerged in severe complications (p = 0.077), reoperation rates (p = 0.227), or time to chemotherapy initiation (p = 0.742). A decreasing trend in thoracostomy tube placement was observed since 2018. Progression-free and overall survival were similar between groups. Despite requiring greater intraoperative effort and resulting in higher postoperative morbidity, DR is not associated with an increased incidence of severe complications (grade 3+) or delayed chemotherapy initiation compared with DS. These findings support the feasibility of DR for achieving complete cytoreduction in advanced OC.