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Purpose <p>The primary objective was to compare the intra- and postoperative outcomes of diaphragmatic stripping versus full-thickness diaphragmatic resection in patients with peritoneal carcinomatosis who underwent cytoreductive surgery.</p> Methods <p>According to the PRSIMA guidelines, a comprehensive literature search was conducted for studies comparing postoperative pulmonary complications as well as intra- and postoperative outcomes of diaphragmatic stripping versus full-thickness diaphragmatic resection in patients with peritoneal carcinomatosis necessitating cytoreductive surgery. Data from eligible studies were extracted, qualitatively assessed, and included in a meta-analysis. Odds ratios (ORs) and standardized mean differences (SMDs) with 95 per cent confidence intervals were calculated.</p> Results <p>Ten studies with 1325 patients were included in this meta-analysis. Diaphragmatic stripping was associated with lower incidence of pleural effusion (OR 0.47, 95% CI 0.35–0.63,&#xa0;<i>p</i> &lt; 0.00001) and pneumothorax (OR 0.52, 95% CI 0.35–0.78,&#xa0;<i>p</i> = 0.002), less severe postoperative complications (Clavien-Dindo Grade ≥ 3) (OR 0.43, 95% CI 0.30–0.63,&#xa0;<i>p</i> &lt; 0.0001), and shorter duration of surgery (SMD -0.31, 95% CI -0.54 – -0.08,&#xa0;<i>p</i> = 0.007). No significant differences were observed in postoperative subdiaphragmatic abscess occurrence, intraoperative blood loss, hospital- and ICU-stay, and 90-day mortality.</p> Conclusions <p>Diaphragmatic stripping leads to a&#xa0;significantly lower rate of postoperative pulmonary and severe complications compared to diaphragmatic full-thickness resection, while oncological outcomes do not appear to be worse. Larger trials with standardized study protocols and long-term survival data are needed to validate the results presented here.</p>

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Diaphragmatic stripping versus full-thickness diaphragmatic resection in cytoreductive surgery: a meta-analysis of the current evidence

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月25日

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  • Maria Chara Stylianidi,
  • Sascha Vaghiri,
  • Alireza Pandkhahi,
  • Sultan Kazziha,
  • Ward Al Akeel,
  • Wolfram Trudo Knoefel,
  • Dimitrios Prassas

摘要

Purpose

The primary objective was to compare the intra- and postoperative outcomes of diaphragmatic stripping versus full-thickness diaphragmatic resection in patients with peritoneal carcinomatosis who underwent cytoreductive surgery.

Methods

According to the PRSIMA guidelines, a comprehensive literature search was conducted for studies comparing postoperative pulmonary complications as well as intra- and postoperative outcomes of diaphragmatic stripping versus full-thickness diaphragmatic resection in patients with peritoneal carcinomatosis necessitating cytoreductive surgery. Data from eligible studies were extracted, qualitatively assessed, and included in a meta-analysis. Odds ratios (ORs) and standardized mean differences (SMDs) with 95 per cent confidence intervals were calculated.

Results

Ten studies with 1325 patients were included in this meta-analysis. Diaphragmatic stripping was associated with lower incidence of pleural effusion (OR 0.47, 95% CI 0.35–0.63, p < 0.00001) and pneumothorax (OR 0.52, 95% CI 0.35–0.78, p = 0.002), less severe postoperative complications (Clavien-Dindo Grade ≥ 3) (OR 0.43, 95% CI 0.30–0.63, p < 0.0001), and shorter duration of surgery (SMD -0.31, 95% CI -0.54 – -0.08, p = 0.007). No significant differences were observed in postoperative subdiaphragmatic abscess occurrence, intraoperative blood loss, hospital- and ICU-stay, and 90-day mortality.

Conclusions

Diaphragmatic stripping leads to a significantly lower rate of postoperative pulmonary and severe complications compared to diaphragmatic full-thickness resection, while oncological outcomes do not appear to be worse. Larger trials with standardized study protocols and long-term survival data are needed to validate the results presented here.