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

Q: What was the main goal of comparing diaphragmatic resection (DR) versus stripping (DS) in advanced ovarian cancer?

To evaluate how DR and DS affect surgical outcomes, postoperative complications, chemotherapy initiation timing, and survival.

Q: How many patients and what stage were included in the study?

A total of 215 patients with FIGO stage III–IV advanced ovarian cancer were analyzed.

Q: Did DR lead to more severe complications or delayed chemotherapy compared with DS?

No. Severe complication rates (grade 3+) and time to chemotherapy initiation did not differ significantly between DR and DS.

Sep 29, 2026

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Complete cytoreductive surgery is central to advanced ovarian cancer care, yet diaphragmatic procedures (stripping vs full-thickness resection) raise concerns about postoperative morbidity and the timing of adjuvant chemotherapy. In this retrospective monocentric cohort of 215 FIGO stage III–IV patients treated between 2011 and 2023, surgical outcomes, Clavien–Dindo–graded complications, chemotherapy initiation time, and survival were compared. Resection showed more thoracic complications and higher oxygen needs, while severe complications and chemotherapy timing were similar; progression-free and overall survival did not differ.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Background

Patients and methods

Results

Conclusions

Keywords

Ann Surg Oncol (2026) 33:1099–1108 [https://doi.org/10.1245/s10434-025-18423-1](https://doi.org/10.1245/s10434-025-18423-1) ORIGINAL ARTICLE – GYNECOLOGIC ONCOLOGY 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 Pietro Pasquini, MD1,2, Lucia Genovesi, MD1,2, Camelia Alexandra Coadă, MD, PhD3, Andi Stermasi, MD4, Francesco Mezzapesa, MD1,2, Stella Di Costanzo, MSc1, Alessandro Bovicelli, MD1,2, Elisabetta Pia Bilancia, MD1,2, Enrico Fiuzzi, MD1,2, Giulia Mantovani, MD1, Pierandrea De Iaco, MD1,2,5, and Anna Myriam Perrone, MD, PhD1,2 1Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 2Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; 3Department of Morpho-functional sciences, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; 4Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy; 5Department of Medical and Surgical Sciences, Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy ABSTRACT Background. 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. Patients and methods. 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. Results. 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 © The Author(s) 2025, corrected publication 2025 First Received: 20 February 2025 Accepted: 11 September 2025 Published online: 4 October 2025 P. De Iaco, MD [e-mail: pierandrea.deiaco@unibo.it](e-mail: pierandrea.deiaco@unibo.it) 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. Conclusions. 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. Keywords Ovarian cancer · Diaphragmatic surgery · Residual disease · Interval debulking surgery · Primary debulking surgery · Chemotherapy Ovarian cancer (OC) is the leading cause of death among women with gynecologic malignancies and the fifth most common cause of cancer-related mortality in women overall. 1 Most cases (80%) are diagnosed at an advanced

FAQs

What was the main goal of comparing diaphragmatic resection (DR) versus stripping (DS) in advanced ovarian cancer?

To evaluate how DR and DS affect surgical outcomes, postoperative complications, chemotherapy initiation timing, and survival.

How many patients and what stage were included in the study?

A total of 215 patients with FIGO stage III–IV advanced ovarian cancer were analyzed.

Did DR lead to more severe complications or delayed chemotherapy compared with DS?

No. Severe complication rates (grade 3+) and time to chemotherapy initiation did not differ significantly between DR and DS.

Sep 29, 2026

Upload by Ivy