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It is estimated that approximately 40% of OC patients have gross disease located on the diaphragm. However, no mature data evaluating outcomes of surgical techniques for the management of diaphragmatic carcinosis exist. In the present study, we aimed to estimate surgery-related morbidity of different surgical techniques for diaphragmatic cytoreduction in advanced or recurrent OC. Methods PubMed (MEDLINE), Web of Science, and Clincaltrials.gov databases were searched for records estimating outcomes of diaphragmatic peritoneal stripping (DPS) or diaphragmatic full-thickness resection (DFTR) for OC. The meta-analysis was performed using the Cochrane Review software. Results For the final analysis, 5 articles were available, including 272 patients. Diaphragmatic peritoneal stripping and DFTR were performed in 197 patients (72%) and 75 patients (28%), respectively. Pooled analysis suggested that the estimated pleural effusion rate was 43% and 51% after DPS and DFTR, respectively. The need for pleural punctures or chest tube placement was 4% and 9% after DPS and DFTR, respectively. The rate of postoperative pneumothorax (4% vs 9%; odds ratio, 0.31; 95% confidence interval, 0.05–2.08) and subdiaphragmatic abscess (3% vs 3%; odds ratio, 0.45; 95% confidence interval, 0.09–2.31) were similar after the execution of DPS and DFTR. Conclusions Diaphragmatic surgery is a crucial step during cytoreduction for advanced or recurrent OC. Obviously, the choice to perform DPS or DFTR depends on the infiltration of the diaphragmatic muscle or not. Both the procedures are associated with a low pulmonary complication and chest tube placement rates." /> <meta name="DC.Contributor" content="Giorgio Bogani" /> <meta name="DC.Contributor" content="Antonino Ditto" /> <meta name="DC.Contributor" content="Fabio Martinelli" /> <meta name="DC.Contributor" content="Domenica Lorusso" /> <meta name="DC.Contributor" content="Valentina Chiappa" /> <meta name="DC.Contributor" content="Cristina Donfrancesco" /> <meta name="DC.Contributor" content="Violante Di Donato" /> <meta name="DC.Contributor" content="Alice Indini" /> <meta name="DC.Contributor" content="Giovanni Aletti" /> <meta name="DC.Contributor" content="Francesco Raspagliesi" /> <meta name="article:published_time" content="2016-02-01" /> <meta name="article:section" content="Surgeons Corner" /> <meta name="citation_title" content="Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma: A Systematic Review and Meta-analysis" /> <meta name="citation_abstract" lang="en" content="<h3>Objective</h3> <p>Optimal cytoreduction is one the main factors improving survival outcomes in patients affected by ovarian cancer (OC). It is estimated that approximately 40% of OC patients have gross disease located on the diaphragm. However, no mature data evaluating outcomes of surgical techniques for the management of diaphragmatic carcinosis exist. In the present study, we aimed to estimate surgery-related morbidity of different surgical techniques for diaphragmatic cytoreduction in advanced or recurrent OC.</p><h3>Methods</h3> <p>PubMed (MEDLINE), Web of Science, and Clincaltrials.gov databases were searched for records estimating outcomes of diaphragmatic peritoneal stripping (DPS) or diaphragmatic full-thickness resection (DFTR) for OC. The meta-analysis was performed using the Cochrane Review software.</p><h3>Results</h3> <p>For the final analysis, 5 articles were available, including 272 patients. Diaphragmatic peritoneal stripping and DFTR were performed in 197 patients (72%) and 75 patients (28%), respectively. Pooled analysis suggested that the estimated pleural effusion rate was 43% and 51% after DPS and DFTR, respectively. The need for pleural punctures or chest tube placement was 4% and 9% after DPS and DFTR, respectively. The rate of postoperative pneumothorax (4% vs 9%; odds ratio, 0.31; 95% confidence interval, 0.05–2.08) and subdiaphragmatic abscess (3% vs 3%; odds ratio, 0.45; 95% confidence interval, 0.09–2.31) were similar after the execution of DPS and DFTR.</p><h3>Conclusions</h3> <p>Diaphragmatic surgery is a crucial step during cytoreduction for advanced or recurrent OC. Obviously, the choice to perform DPS or DFTR depends on the infiltration of the diaphragmatic muscle or not. Both the procedures are associated with a low pulmonary complication and chest tube placement rates.</p>" /> <meta name="citation_journal_title" content="International Journal of Gynecologic Cancer" /> <meta name="citation_publisher" content="BMJ Specialist Journals" /> <meta name="citation_publication_date" content="2016/02/01" /> <meta name="citation_mjid" content="ijgc;26/2/371" /> <meta name="citation_id" content="26/2/371" /> <meta name="citation_public_url" content="https://ijgc.bmj.com/content/26/2/371" /> <meta name="citation_abstract_html_url" content="https://ijgc.bmj.com/content/26/2/371.abstract" /> <meta name="citation_full_html_url" content="https://ijgc.bmj.com/content/26/2/371.full" /> <meta name="citation_pdf_url" content="https://ijgc.bmj.com/content/ijgc/26/2/371.full.pdf" /> <meta name="citation_issn" content="1048-891X" /> <meta name="citation_issn" content="1525-1438" /> <meta name="citation_doi" content="10.1097/IGC.0000000000000597" /> <meta name="citation_pmid" content="26588238" /> <meta name="citation_volume" content="26" /> <meta name="citation_issue" content="2" /> <meta name="citation_article_type" content="Research Article" /> <meta name="citation_section" content="Surgeons Corner" /> <meta name="citation_author" content="Giorgio Bogani" /> <meta name="citation_author_institution" content="Department of Gynecologic Oncology, IRCCS National Cancer Institute; and" /> <meta name="citation_author" content="Antonino Ditto" /> <meta name="citation_author_institution" content="Department of Gynecologic Oncology, IRCCS National Cancer Institute; and" /> <meta name="citation_author" content="Fabio Martinelli" /> <meta name="citation_author_institution" content="Department of Gynecologic Oncology, IRCCS National Cancer Institute; and" /> <meta name="citation_author" content="Domenica Lorusso" /> <meta name="citation_author_institution" content="Department of Gynecologic Oncology, IRCCS National Cancer Institute; and" /> <meta name="citation_author" content="Valentina Chiappa" /> <meta name="citation_author_institution" content="Department of Gynecologic Oncology, IRCCS National Cancer Institute; and" /> <meta name="citation_author" content="Cristina Donfrancesco" /> <meta name="citation_author_institution" content="Department of Gynecologic Oncology, IRCCS National Cancer Institute; and" /> <meta name="citation_author" content="Violante Di Donato" /> <meta name="citation_author_institution" content="Department of Gynecologic Oncology, IRCCS National Cancer Institute; and" /> <meta name="citation_author" content="Alice Indini" /> <meta name="citation_author_institution" content="Department of Gynecologic Oncology, IRCCS National Cancer Institute; and" /> <meta name="citation_author" content="Giovanni Aletti" /> <meta name="citation_author_institution" content="Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy." /> <meta name="citation_author" content="Francesco Raspagliesi" /> <meta name="citation_author_institution" content="Department of Gynecologic Oncology, IRCCS National Cancer Institute; and" /> <meta name="twitter:title" content="Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma: A Systematic Review and Meta-analysis" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:image" content="https://ijgc.bmj.com/pages/wp-content/uploads/sites/73/2019/07/ijgc-social-media-card.jpg" /> <meta name="twitter:description" content="Objective Optimal cytoreduction is one the main factors improving survival outcomes in patients affected by ovarian cancer (OC). It is estimated that approximately 40% of OC patients have gross disease located on the diaphragm. However, no mature data evaluating outcomes of surgical techniques for the management of diaphragmatic carcinosis exist. In the present study, we aimed to estimate surgery-related morbidity of different surgical techniques for diaphragmatic cytoreduction in advanced or recurrent OC. Methods PubMed (MEDLINE), Web of Science, and Clincaltrials.gov databases were searched for records estimating outcomes of diaphragmatic peritoneal stripping (DPS) or diaphragmatic full-thickness resection (DFTR) for OC. The meta-analysis was performed using the Cochrane Review software. Results For the final analysis, 5 articles were available, including 272 patients. Diaphragmatic peritoneal stripping and DFTR were performed in 197 patients (72%) and 75 patients (28%), respectively. Pooled analysis suggested that the estimated pleural effusion rate was 43% and 51% after DPS and DFTR, respectively. The need for pleural punctures or chest tube placement was 4% and 9% after DPS and DFTR, respectively. The rate of postoperative pneumothorax (4% vs 9%; odds ratio, 0.31; 95% confidence interval, 0.05–2.08) and subdiaphragmatic abscess (3% vs 3%; odds ratio, 0.45; 95% confidence interval, 0.09–2.31) were similar after the execution of DPS and DFTR. Conclusions Diaphragmatic surgery is a crucial step during cytoreduction for advanced or recurrent OC. Obviously, the choice to perform DPS or DFTR depends on the infiltration of the diaphragmatic muscle or not. Both the procedures are associated with a low pulmonary complication and chest tube placement rates." /> <meta name="og-title" property="og:title" content="Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma: A Systematic Review and Meta-analysis" /> <meta name="og-url" property="og:url" content="https://ijgc.bmj.com/content/26/2/371" /> <meta name="og-site-name" property="og:site_name" content="International Journal of Gynecologic Cancer" /> <meta name="og-description" property="og:description" content="Objective Optimal cytoreduction is one the main factors improving survival outcomes in patients affected by ovarian cancer (OC). It is estimated that approximately 40% of OC patients have gross disease located on the diaphragm. However, no mature data evaluating outcomes of surgical techniques for the management of diaphragmatic carcinosis exist. In the present study, we aimed to estimate surgery-related morbidity of different surgical techniques for diaphragmatic cytoreduction in advanced or recurrent OC. Methods PubMed (MEDLINE), Web of Science, and Clincaltrials.gov databases were searched for records estimating outcomes of diaphragmatic peritoneal stripping (DPS) or diaphragmatic full-thickness resection (DFTR) for OC. The meta-analysis was performed using the Cochrane Review software. Results For the final analysis, 5 articles were available, including 272 patients. Diaphragmatic peritoneal stripping and DFTR were performed in 197 patients (72%) and 75 patients (28%), respectively. Pooled analysis suggested that the estimated pleural effusion rate was 43% and 51% after DPS and DFTR, respectively. The need for pleural punctures or chest tube placement was 4% and 9% after DPS and DFTR, respectively. The rate of postoperative pneumothorax (4% vs 9%; odds ratio, 0.31; 95% confidence interval, 0.05–2.08) and subdiaphragmatic abscess (3% vs 3%; odds ratio, 0.45; 95% confidence interval, 0.09–2.31) were similar after the execution of DPS and DFTR. Conclusions Diaphragmatic surgery is a crucial step during cytoreduction for advanced or recurrent OC. Obviously, the choice to perform DPS or DFTR depends on the infiltration of the diaphragmatic muscle or not. Both the procedures are associated with a low pulmonary complication and chest tube placement rates." /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://ijgc.bmj.com/pages/wp-content/uploads/sites/73/2019/07/ijgc-social-media-card.jpg" /> <title>Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma: A Systematic Review and Meta-analysis | International Journal of Gynecologic Cancer</title> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__zEtNwUu9MaBwPq3JhYABsUEb8zJetUS42Q04qTPWDcc__wUr2GCCXq5CGuNFk2jmV52iytGLjUd7dn7guJp7QOB0__RDn7aIfjZIdXcl7wVtBcJLKS2b-1gFRdOHlwuadkoAo.css" media="all" /> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__gzhCDL7s2DdMqxGYgWxUMcRJhFfthtVcV5dQFZdV090__yAkxBLUKwF6cHyMzviVeuMUXsvTJC8gS_7UFjY1cM_0__RDn7aIfjZIdXcl7wVtBcJLKS2b-1gFRdOHlwuadkoAo.css" media="all" /> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__s27kGxLMTJcJhg1XDW_9_0Dhn7ft1W-e4jlOnyd7SEo__sXFYuF13EFhuf6XoVwDz0s9rF7BBCr1PbIj-xDo_9vQ__RDn7aIfjZIdXcl7wVtBcJLKS2b-1gFRdOHlwuadkoAo.css" media="all" /> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__49Q5Oqxf94h_o5t2rL_PJGi_lJCCSCB6bNHnQMAPzI8__ndhN8J2Jh8vzutPoTD8e6WYLEOj7xd-3bf1clgdpI8g__RDn7aIfjZIdXcl7wVtBcJLKS2b-1gFRdOHlwuadkoAo.css" media="all" /> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__NvPps8JjGu4XsoLylFhzRC77nMIeWUF3-Rxl1gWW090__WcSYsek5AmWdrYBEq5QSHiOY7a_XCh1A_j0efkZ26FQ__RDn7aIfjZIdXcl7wVtBcJLKS2b-1gFRdOHlwuadkoAo.css" media="all" /> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__-BkZ71IF4pBXmZfP4vYyswWdIhuaKktrUUQ4i2vtUVo__0i_0YcYkMECNn0z7FdhNoJ8gLWleqnTtjnHRAmLijvc__RDn7aIfjZIdXcl7wVtBcJLKS2b-1gFRdOHlwuadkoAo.css" media="all" />  <script src="https://cookie-cdn.cookiepro.com/scripttemplates/otSDKStub.js" type="text/javascript" charset="UTF-8" data-domain-script="565e50dd-f6e9-46d6-91cd-5c40a270264f"></script> <script type="text/javascript"> function OnetrustAdsConsent(){ if(googletag.apiReady){ //console.log("GoogleTag API ready") googletag.pubads().disableInitialLoad(); 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/><strong>PDF</strong></a></a> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-entity-field pane-node-field-highwire-article-cat article-category col-narrow-9 col-normal-10" > <div class="pane-content"> <div class="field field-name-field-highwire-article-cat field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">Surgeons Corner</div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-article-citation col-mobile-10 col-narrow-10 col-normal-11 article-title" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node2238" data-node-nid="2238" id="node-2238--21932800924" data-pisa="ijgc;26/2/371" data-pisa-master="ijgc;10.1097/IGC.0000000000000597" data-apath="/ijgc/26/2/371.atom"><cite class="highwire-cite highwire-cite-highwire-article highwire-citation-bmjj-title clearfix"> <div class="highwire-cite-title">Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma: A Systematic Review and Meta-analysis</div> <span class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="ijgc;10.1097/IGC.0000000000000597" data-atom-uri="/ijgc/26/2/371.atom" data-request-view="full"></span></span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container col-narrow-12 clear" > <div class="pane-content"> <div data-panels-ajax-tab-preloaded="jnl_template_bmjj_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://ijgc.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_template_bmjj_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup author-affiliates col-narrow-12 author-affiliates-corresp article" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">Giorgio Bogani</span><span class="contrib-degrees">, MD</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">*</a>, </li><li class="contributor" id="contrib-2"><span class="name">Antonino Ditto</span><span class="contrib-degrees">, MD</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">*</a>, </li><li class="contributor" id="contrib-3"><span class="name">Fabio Martinelli</span><span class="contrib-degrees">, MD</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">*</a>, </li><li class="contributor" id="contrib-4"><span class="name">Domenica Lorusso</span><span class="contrib-degrees">, MD</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1">*</a>, </li><li class="contributor" id="contrib-5"><span class="name">Valentina Chiappa</span><span class="contrib-degrees">, MD</span><a id="xref-aff-1-5" class="xref-aff" href="#aff-1">*</a>, </li><li class="contributor" id="contrib-6"><span class="name">Cristina Donfrancesco</span><span class="contrib-degrees">, MD</span><a id="xref-aff-1-6" class="xref-aff" href="#aff-1">*</a>, </li><li class="contributor" id="contrib-7"><span class="name">Violante Di Donato</span><span class="contrib-degrees">, MD</span><a id="xref-aff-1-7" class="xref-aff" href="#aff-1">*</a>, </li><li class="contributor" id="contrib-8"><span class="name">Alice Indini</span><span class="contrib-degrees">, MD</span><a id="xref-aff-1-8" class="xref-aff" href="#aff-1">*</a>, </li><li class="contributor" id="contrib-9"><span class="name">Giovanni Aletti</span><span class="contrib-degrees">, MD</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">†</a> and </li><li class="last" id="contrib-10"><span class="name">Francesco Raspagliesi</span><span class="contrib-degrees">, MD</span><a id="xref-aff-1-9" class="xref-aff" href="#aff-1">*</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>*</sup><span class="addr-line">Department of Gynecologic Oncology, IRCCS National Cancer Institute; and</span></address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>†</sup><span class="addr-line">Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy.</span></address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Address correspondence and reprint requests to Giorgio Bogani, MD, IRCCS Foundation, National Cancer Institute, Via Venezian 1, 20133 Milan, Italy. E-mail: <a href="http://giorgio.bogani@istitutotumori.mi.it">giorgio.bogani@istitutotumori.mi.it</a>.</li></ol></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup abstract-with-bc" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" id="content-block" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-3"><strong>Objective</strong> Optimal cytoreduction is one the main factors improving survival outcomes in patients affected by ovarian cancer (OC). It is estimated that approximately 40% of OC patients have gross disease located on the diaphragm. However, no mature data evaluating outcomes of surgical techniques for the management of diaphragmatic carcinosis exist. In the present study, we aimed to estimate surgery-related morbidity of different surgical techniques for diaphragmatic cytoreduction in advanced or recurrent OC.</p></div><div id="sec-2" class="subsection"><p id="p-4"><strong>Methods</strong> PubMed (MEDLINE), Web of Science, and Clincaltrials.gov databases were searched for records estimating outcomes of diaphragmatic peritoneal stripping (DPS) or diaphragmatic full-thickness resection (DFTR) for OC. The meta-analysis was performed using the Cochrane Review software.</p></div><div id="sec-3" class="subsection"><p id="p-5"><strong>Results</strong> For the final analysis, 5 articles were available, including 272 patients. Diaphragmatic peritoneal stripping and DFTR were performed in 197 patients (72%) and 75 patients (28%), respectively. Pooled analysis suggested that the estimated pleural effusion rate was 43% and 51% after DPS and DFTR, respectively. The need for pleural punctures or chest tube placement was 4% and 9% after DPS and DFTR, respectively. The rate of postoperative pneumothorax (4% vs 9%; odds ratio, 0.31; 95% confidence interval, 0.05–2.08) and subdiaphragmatic abscess (3% vs 3%; odds ratio, 0.45; 95% confidence interval, 0.09–2.31) were similar after the execution of DPS and DFTR.</p></div><div id="sec-4" class="subsection"><p id="p-6"><strong>Conclusions</strong> Diaphragmatic surgery is a crucial step during cytoreduction for advanced or recurrent OC. Obviously, the choice to perform DPS or DFTR depends on the infiltration of the diaphragmatic muscle or not. Both the procedures are associated with a low pulmonary complication and chest tube placement rates.</p></div></div><ul class="kwd-group"><li class="kwd">Ovarian cancer</li><li class="kwd">Diaphragmatic surgery</li><li class="kwd">Pulmonary complications</li><li class="kwd">Morbidity</li><li class="kwd">Survival</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-dfp-pane oas-ads oas-ads-mid pull-right" > <div class="pane-content"> <div id="dfp-ad-mpu-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-mpu" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-mpu"); }); </script> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-1" > <div class="pane-content"> <p><a href="https://doi.org/10.1097/IGC.0000000000000597" target="_new">https://doi.org/10.1097/IGC.0000000000000597</a></p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-altmetrics" > <h2 class="pane-title">Statistics from Altmetric.com</h2> <div class="pane-content"> <div data-badge-details="right" data-badge-type="medium-donut" data-doi="10.1097/IGC.0000000000000597" data-hide-no-mentions="true" class="altmetric-embed"></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmjj-jumplinks" > <div class="pane-content"> <div class="highwire-list-wrapper"><div class="highwire-list"><ul></ul></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-2 permissions-box" > <h2 class="pane-title">Request Permissions</h2> <div class="pane-content"> <p>If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. 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