Divya Panyam Vuppu

Evaluating the tozzi classification system in diaphragm surgeries for advanced ovarian cancer: Clinical applicability and perioperative outcomes

Over 70 % of advanced ovarian cancer cases involve metastasis to the peritoneum, diaphragm, and liver. Standardised diaphragm surgeries are vital for achieving complete cytoreduction and enhancing patient prognosis. This study evaluates the clinical utility of Tozzi's classification for diaphragm surgeries and examines perioperative outcomes in advanced ovarian cancer debulking. Patients who underwent diaphragm surgery during cytoreductive procedures for ovarian cancer were classified using Tozzi's classification based on disease extent, and liver mobilisation and perioperative outcomes were analysed. Among 38 patients (71 % stage III; 52.6 % interval surgeries), 39.4 % were Type I, 28.9 % Type II, and 31.5 % Type III. Ascites was more common in Type II (77.8 %, p = 0.04), while Type III had more imaging-detected lesions (83.3 %, p = 0.03). Type III surgeries required longer durations (405 ± 136 min, p = 0.04) and more intraoperative interventions (58.3 %, p = 0.01). ICU care was needed in 50 % of cases, with a median stay of two days, mainly for Type III. Pulmonary complications occurred in 10.5 %, and the median hospital stay was six days. Tozzi's classification predicts surgical complexity and morbidity, particularly for Type III cases, aiding surgical planning and optimising patient outcomes.

Giant cell carcinoma resembling the lung in the ovary: challenges and treatment approaches

Giant cell carcinoma (GCC) resembling the lung in the ovary is a rare and aggressive tumour with no established standard treatment options. In this case, a postmenopausal woman in her 50s with hypothyroidism underwent surgery for a left ovarian mass. Due to dense adhesions to the sigmoid colon, the procedure was abandoned, and she was referred to our centre. Imaging showed a necrotic pelvic mass involving adjacent organs, omental nodules and para-aortic lymphadenopathy. Her initial biopsy showed an undifferentiated carcinoma with giant cells, resembling GCC of the lung, which was confirmed by immunohistochemistry. Three cycles of carboplatin and paclitaxel reduced the tumour, enabling successful interval debulking surgery. The patient completed three more cycles and has been recurrence-free for 18 months. In this case, the use of neoadjuvant chemotherapy likely contributed to better disease control, facilitating a complete resection during the interval surgery.