Objectives. Compare the surgical morbidity of diaphragmatic peritonectomy versus full thickness diaphragmatic resection with pleurectomy at radical debulking. Design. Prospective cohort study at the Oxford University Hospital. Methods. All debulking with diaphragmatic peritonectomy and/or full thickness resection with pleurectomy in the period from April 2009 to March 2012 were part of the study. Analysis is focused on the intra- and postoperative morbidity. Results. 42 patients were eligible for the study, 21 underwent diaphragmatic peritonectomy (DP, group 1) and 21 diaphragmatic full thickness resection (DR, group 2). Forty patients out of 42 (93%) had complete tumour resection with no residual disease. Histology confirmed the presence of cancer in diaphragmatic peritoneum of 19 patients out of 21 in group 1 and all 21 patients of group 2. Overall complications rate was 19% in group 1 versus 33% in group 2. Pleural effusion rate was 9.5% versus 14.5% and pneumothorax rate was 14.5% only in group 2. Two patients in each group required postoperative chest drains (9.5%). Conclusions. Diaphragmatic surgery is an effective methods to treat carcinomatosis of the diaphragm. Patients in the pleurectomy group experienced pneumothorax and a higher rate of pleural effusion, but none had long-term morbidity or additional surgical interventions. 1. Introduction Ovarian cancer remains a lethal disease for patients with advanced disease. Despite medical progresses, the survival figures of ovarian cancer did not significantly improve [1]. Whilst every year 200.000 women are diagnosed with ovarian cancer globally, 125.000 will die of disease [2]. The lack of an effective screening test and a delayed diagnosis are the reasons for this high rate of lethality. In fact, over 75% of the patients will be allocated to a FIGO stage III or IV at time of diagnosis, with involvement of the upper abdomen. The residual disease following surgery remains the single most important independent prognostic factor in patients with ovarian cancer [3–6], regardless of the timing of the surgery [7]. The lesser the residual disease at the end of the surgery, the better is the prognosis. Patients left with no visible disease are associated with the best outcome [5–9]. In order to achieve a complete extirpation of the cancer, often a multivisceral surgery is necessary [10]. Despite being anatomically distant from the organ of origin, the upper abdomen and the diaphragm are often involved in patients with ovarian cancer. A survey of the Society of Gynaecologic Oncology based on 1965 patients
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