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Updated: Sep 8, 2025
A Coregistered Ultrasound and Photoacoustic Imaging Protocol for the Transvaginal Imaging of Ovarian Lesions
Published on: March 3, 2023
Evaluating the tozzi classification system in diaphragm surgeries for advanced ovarian cancer: Clinical applicability
Divya Panyam Vuppu1, Priya Bhati1, Saumya Gupta1
1Department of Gynaecological Oncology, Amrita Institute of Medical Sciences, Kochi, India.
Background:
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.
Aim:
This study evaluates the clinical utility of Tozzi's classification for diaphragm surgeries and examines perioperative outcomes in advanced ovarian cancer debulking.
Methods:
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.
Results:
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.
Conclusion:
Tozzi's classification predicts surgical complexity and morbidity, particularly for Type III cases, aiding surgical planning and optimising patient outcomes.
