The “Sandwich-Technique” of diaphragmatic stripping or full-thickness resection for advanced ovarian cancer: how to keep it fast and simple

Objective: Residual tumor is the most important prognostic factor in advanced ovarian cancer patients. A recent analysis from a large GOG trial identified the diaphragm as the most common localization for residual tumor after surgery in advanced ovarian cancer. This stresses the need for more knowledge and training in diaphragmatic surgery in patients with advanced ovarian cancer.

Methods/materials: We aim to describe a safe, structured technique to perform resection of the peritoneal diaphragm or full thickness resection of the diaphragm.

Results: The structured technique consists of five steps: 1. Knowledge of the anatomical landmarks, 2. adequate exposure of the surgical field, 3. mobilization of the liver, 4. demarcation of the resection lines of the peritoneum, 4. mobilization of the diaphragmatic peritoneum by using the “sandwich technique” or performance of a full thickness resection with subsequent suture.

Conclusion: Diaphragmatic surgery is an important part of upper abdominal surgery in advanced ovarian cancer patients. It is a safe, structured procedure, which should be routinely performed to achieve optimal surgical results for these patients.