Diaphragmatic surgery in advanced ovarian cancer therapy

Authors: V. Kalist 1;  P. Havelka 1;  M. Mlčoch 1;  Z. Adamík 1;  J. Klein 2,3
Authors‘ workplace: Gynekologicko-porodnické oddělení, Krajská nemocnice T. Bati, a. s., Zlín, přednosta MUDr. Z. Adamík, Ph. D. 1;  Chirurgické oddělení, Krajská nemocnice T. Bati, a. s., Zlín, přednosta prof. MUDr. J. Klein, Ph. D. 2;  Fakulta zdravotníctva, Trenčianska univerzita Alexandra Dubčeka, Trenčín, Slovenská republika 3
Published in: Ceska Gynekol 2015; 80(5): 333-338


Advanced ovarian cancer is a lethal disease. More than 75% of women with ovarian cancer are diagnosed in advanced stage FIGO IIIC–IV. The combination of surgical cytoreduction without residual tumor, and chemotherapy is the only way to prolong overall survival of women with advanced ovarian cancer.

Systematic review.

Subject and methods:
Current literature review.

Due to frequent involvement of the diaphragm in women with advanced ovarian cancer and the effort of optimal debulking is the inclusion of diaphragmatic surgery necessary for so affected women. Diaphragmatic surgery increases the rates of optimal cytoreduction, improves survival of women with advanced ovarian cancer and has acceptable morbidity rate.

advanced ovarian cancer, diaphragmatic surgery, optimal debulking, residual disease


1. Aletti, GD., Dowdy, SC., Podratz, KC., Cliby,WA. Surgical treatment of diaphragm disease correlates with improved survival in optimally debulked advanced stage ovarian cancer. Gynecol Oncol, 2006, 100, p. 283–287.

2. Aletti, GD., Gallenberg, MM., Cliby,WA., et al. Current management strategies for ovarian cancer. Mayo clinic proceedings, 2007, 82(6), p. 751–770.

3. Bashir, S., Geradi, MA., Giuntoli II, RL., et al. Surgical technice of diafragma full-thickness resection and trans-diaphragmatic decompression of pneumothorax during cytoreductive surgery for ovarian cancer. Gynecol Oncol, 2010, 119, p. 255–258.

4. Bristow, RE., Tomacrus, RS., Armstrong, DK., et al. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a metanalysis. J Clinical Oncol, 2002, 20, p. 1248–1259.

5. Cliby,W., Dowdy, S., Feitoza, S., et al. Diaphragm resection for ovarian cancer: technice and short-term complications. Gynecol Oncol, 2004, 94, p. 655–660.

6. Čihák, R. Anatomie 2. Praha: Grada, 1986, s. 123–125.

7. Du Bois, A., Reuss, A., Pujade-Lauraine, E., et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 mulicentrer trials: by the arbeitsgemeinschaft gynaekologische onkologie studiengruppe ovarialkarzinom (AGO-OVAR) and the grupe d´Investigateurs nationaux pour les etudes des cancers de I´Ovaire (GINECO). Cancer, 2009, 115, 6, p. 1234–1244.

8. Einekel, J. Techniques of diaphragmatic surgery. http://www.esgo.org/Education/ PublishingImages /119.pdf.

9. Einekel, J., Ott, R., Bauman, UD., et al. Characteristics and management of diaphragm involvement in patiens with primary advanced-stage ovarian, Falopian tube or peritoneal cancer. Intern J Gynecol Cancer, 19, p. 1288–1297.

10. Eisenhauer, EL., D´Angelica, MI., Abu-Rustum, NR., et al. Incidence and management of pleural effusion after diaphragm peritonectomy or resection for advanced mullerian cancer. Gynecol Oncol, 2006, 103, p. 871–877.

11. Eisenhauer, EL., Chi, DS. Liver mobilization and diaphragm peritonectomy/ resection. Gynecol Oncol, 2007, 104, p. S25–S28.

12. Eisenkop, SM., Spirtos, NM. What are the current surgical objectives, strategies, and technical capabilities of gynecologic oncologists treating advanced epithelial ovarian cancer? Gynecol Oncol, 2001, 82, p. 489–497.

13. Fanfany, F., Gagotti, A., Gallotta, V., et al. Upper abdominal surgery in advanced and reccurent ovarian cancer: Role of diaphragmatic surgery. Gynecol Oncol, 2010, 160, p. 497–501.

14. Griffiths, CT. Surgical resection of tumor bulk in the primary treatmnet of ovarian carcinoma. NCI Monogr, 1975, 42, p. 101–104.

15. Gouy, S., Chereau, E., Custodio, AS., et al. Surgical procedures and morbidites of diaphragmatic surgery in patients undergoing initial or interval debulking surgery for advanced-stage ovarian cancer. J Amer College Surg, 2010, 210, p. 509–514.

16. Halkia, E., Efstathiou, E., Spiliotis, J., et al. Management of diaphragmatic peritoneal carcinomatosis: surgical anatomy guidelines and results. JBUON, 2014, 19(1), p. 29–33.

17. Hoskins, WJ., McGuire, WP., Brady, MF., et al. The effect of diameter of largest residual disease on survival after primary cystoreductive sugery in patients with suboptimal residual epithelial ovarian carcinoma. Amer J Obstet Gynecol, 1994, 170, p. 974–979.

18. Chéreau, E., Rouzier, R., Gouy, S., et al. Morbidity of diaphragmatic surgery for advanced ovarian cancer: Retrospective study of 148 cases. Eur J Surg Oncol, 2011, 37(2), p. 175–180.

19. Chi, DS., Eisenhauer, EL., Lang, J., et al. What is the optimal goal of primary cytoreductive Surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Gynecol Oncol, 2006, 103, p. 559–564.

20. Kapnik, JS., Griffiths, TC., Finkler, NJ. Ocult pleural involvement in stage III ovarian carcinoma: role of diaphragmatic resection. Gynecol Oncol, 1990, 39(2), p. 135–138.

21. Kehoe, SM., Eisenhauer, EL., Chi, DS. Upper abdominal surgical procedures: Liver mobilization and diaphragm peritonectomy/resection, splenectomy, and distal pancreatectomy. Gynecol Oncol, 2008, 111, p. S51–S55.

22. Papadia, A., Morotti, M. Diaphragmatic surgery during cytoreduction for primary or recurrent epithelial ovarian cancer: a review of the literatue. Arch Gynecol Obstet, 2013, 287, p. 733–741.

23. Pathiraja, PNJ., Garuto-Campanile, R., Tozzi, R. Diaphragmatic peritonectomy versus full thickness diaphragmatic resection and pleurectomy during cytoreduction in patiens with ovarian cancer. Intern J Surg Oncol, Article ID 876150, 2013, 6 pages, http://www.hindawi.com/journals/ijso/2013/876150/.

24. Shih, KK., Chi, DS. Maximal cytoreductive effort in epithelial ovarian cancer surgery. J Gynecol Oncol, 2010, 21, 2, p. 75–80.

25. Tsolakidis, D., Amant, F., Van Gorp, T., et al. Diaphragmatic surgery during primary debulking in 89 patients with stage IIIB-IV epithelial ovarian cancer. Gynecol Oncol, 2010, 116, p. 489–496.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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