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.
