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Peritonectomy and stripping the diaphragm: what the surgeon does and why | CION Cancer Clinics
Peritonectomy means peeling away part of the thin lining of the abdomen because cancer has settled on it. Diaphragm stripping is the same thing done on the underside of the breathing muscle, behind the liver, where ovarian cancer often collects. Both are part of debulking surgery. The lining grows back, nothing underneath it is removed, and this page explains what the operation involves and what it cannot tell you. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What are peritonectomy and diaphragm stripping?
- Which parts of the lining are usually stripped?
- How is the diaphragm actually stripped?
- Peritonectomy alone compared with diaphragm stripping
- Four things families ask about stripping the lining, and what is true
- Who this does not suit, and what this page cannot tell you
- Common questions about peritonectomy and diaphragm stripping
The short answer
What are peritonectomy and diaphragm stripping?
Peritonectomy means peeling away part of the peritoneum, the thin lining that covers the inside of the abdomen and its organs, because cancer has settled on it. Diaphragm stripping is the same thing done on the underside of the diaphragm, the breathing muscle that sits between the chest and the belly. Both are done during debulking surgery when cancer has spread across these surfaces.
Why the lining is peeled rather than the deposits cut out
Ovarian cancer, and some bowel and appendix cancers, spread by shedding cells that settle across the lining like seed on a field. Peeling the whole sheet away, deposits and all, is more thorough than cutting out each dot. The lining grows back on its own.
Why the diaphragm gets its own name
The underside of the right diaphragm is one of the most common places for ovarian cancer to collect, because fluid in the abdomen flows up there with every breath. It is also the hardest place to reach, tucked behind the liver. Stripping it needs the liver to be gently moved aside, which is why it appears as a separate line on the consent form and adds time to the operation.
Peritonectomy is not the same as removing an organ. Nothing underneath the lining is taken, only the sheet that covers it.Area by area
Which parts of the lining are usually stripped?
The consent form may name several of these. The surgeon strips only the areas that carry cancer, and decides which once the abdomen is open.
Pelvic peritoneum
The lining of the lowest part of the abdomen, around the womb, bladder and rectum. It is almost always involved in ovarian cancer and is often removed together with the womb and ovaries in one piece.
Right diaphragm
The most common upper-abdomen site. The liver is moved aside and the lining beneath the diaphragm is peeled off. Where cancer has grown into the muscle, a small piece of diaphragm may be removed and stitched.
May mean afterwards
- A chest drain for a few days
- Breathing exercises from the physiotherapist
Paracolic gutters
The channels running down either side of the abdomen, outside the large bowel. Fluid pools here, so deposits are common.
Liver surface and the lesser sac
Cancer can sit on the outer covering of the liver and in the pocket behind the stomach. The covering can be peeled without cutting into the liver itself.
Left diaphragm and spleen area
Less often involved than the right side. When it is, the spleen sits in the way and may need to be removed to strip the lining properly. If that is a possibility, it will be on your consent form.
Not sure whether this applies to you?
Ask an oncologistInside the operation
How is the diaphragm actually stripped?
Freeing the liver
The ligaments holding the liver in place are divided so it can be tilted downwards and away from the diaphragm. This is what makes the underside of the diaphragm visible.
Lifting the lining
The surgeon makes a small cut at the edge of the affected area and peels the lining away from the muscle in one sheet, sealing tiny blood vessels as they go. The deposits come away with it.
Checking the muscle
If the cancer has grown through the lining into the diaphragm itself, that piece of muscle is cut out and the gap is closed with stitches. If the chest cavity has been opened, a drain is placed.
Sending it for testing
The stripped lining goes to the pathologist. The report will say whether cancer was found in it and how deep it went, which helps set the stage and plan chemotherapy.
Side by side
Peritonectomy alone compared with diaphragm stripping
Peritonectomy of the pelvis or gutters
Stripping the diaphragm
Lining is peeled from the pelvic wall or the sides of the abdomen
Lining is peeled from the breathing muscle, behind the liver
Adds modest time to the operation
Adds more time, and the liver has to be moved
Rarely affects breathing afterwards
Can cause fluid around the lung and shallow breathing for some days
Chest drain not usually needed
Chest drain sometimes needed if the chest cavity was entered
Physiotherapy is general, for getting moving
Physiotherapy includes deep breathing exercises from the first day
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One thing that cannot wait after diaphragm surgery
Breathlessness that comes on suddenly, or gets worse hour by hour, in the days or weeks after diaphragm stripping needs same-day care. Fluid can collect around the lung, or a clot can form. Go to the nearest emergency department and say you have had abdominal cancer surgery involving the diaphragm. Do not wait to see if it settles overnight, and do not put it down to the anaesthetic.
Commonly believed
Four things families ask about stripping the lining, and what is true
"If the cancer has reached the diaphragm, surgery is pointless."
Cancer on the diaphragm is common in advanced ovarian cancer, and stripping it is a routine part of debulking at centres that do this work. Whether surgery is right for you depends on the whole picture, not on this one site.
"She will not be able to breathe properly without that lining."
The lining is a thin sheet, not part of the breathing muscle. The diaphragm keeps working. Breathing can feel shallow for a few days because of pain and fluid, which is why the physiotherapist starts exercises early.
"Once the lining is gone, cancer cannot come back there."
The lining grows back, and cancer cells too small to see can remain. Chemotherapy after surgery is given for that reason. The operation removes what can be seen; it does not seal the area.
"Peritonectomy is the same as HIPEC."
They are different. Peritonectomy is the peeling of the lining. HIPEC is warmed chemotherapy washed through the abdomen at the end of some operations. Some centres do both together for certain cancers; ask your surgeon what is planned for you and why.
Being straight with you
Who this does not suit, and what this page cannot tell you
Stripping the diaphragm adds hours to an already long operation, and it is not offered to everyone. If the lungs or heart are weak, if the cancer has grown deeply into the diaphragm on both sides, or if it is spread so widely elsewhere that clearing the diaphragm would not change the result, the team may decide not to do it.
What recovery tends to involve
Expect a few days of shallow breathing and a physiotherapist asking you to breathe deeply and cough when you would rather not. Expect pain under the ribs and sometimes in the shoulder tip, which comes from the diaphragm and settles. If a chest drain was placed, it comes out once the fluid stops collecting.
What this page cannot decide
It cannot tell you whether your diaphragm is involved, whether it can be stripped safely, or what the operation will mean for the years ahead. Those come from your scans, your fitness and the surgeon who will be in the room. Ask them how often they do this operation, whether they expect to open the chest cavity, and what the plan is if the cancer has grown into the muscle.
Bring your CT report to the appointment. The radiologist often comments on the diaphragm and liver surface, and the surgeon will want to see the pictures, not only the words.Questions we are asked
Common questions about peritonectomy and diaphragm stripping
Does the lining grow back after peritonectomy?
Yes. The peritoneum heals over within a few weeks, in the same way the inside of a wound heals. What is removed is the cancer sitting on it and the layer it was attached to.
Will I need a chest drain?
Only if the chest cavity is opened during stripping, which happens when cancer has grown through the diaphragm and a piece has to be removed. The drain is a soft tube between the ribs, and it usually comes out within a few days.
Why does my shoulder hurt after abdominal surgery?
The diaphragm shares a nerve with the shoulder tip, so irritation of the diaphragm is felt in the shoulder. It is common after stripping and usually settles over a week or two. Tell the team so the pain medicines can be adjusted; it should not stop you breathing deeply.
Is diaphragm stripping done at every hospital?
No. It needs a surgeon and team who do it often, together with an intensive care unit ready for a long operation. Ask the centre directly how many of these operations they do and who will be operating.
Can peritonectomy be done by keyhole?
Small areas sometimes can, but extensive peritonectomy with diaphragm stripping is almost always an open operation through a long cut, because the surgeon needs to see and feel every surface and move the liver safely. Ask your centre what they are planning and why.
Will fluid keep building up in my abdomen afterwards?
Ascites, the fluid that collects when cancer coats the lining, usually settles once the deposits are removed and chemotherapy begins. Some fluid in the first days after surgery is normal and drains away. If your belly swells again weeks later, tell your oncologist rather than waiting for the next appointment.
How long does the operation take with stripping added?
Longer than a debulking without it, and the exact time depends on how many areas are involved and how stuck the deposits are. Your surgeon can give a realistic range before the day.
Does stripping the diaphragm mean I will have HIPEC too?
Not necessarily. HIPEC is a separate step that some centres add for certain cancers, and it has its own risks and evidence. Whether it is offered depends on the type of cancer and the centre. Ask your surgeon whether it is being considered, and if so, what the evidence is for your cancer.
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Sources
- Cancer Research UK — Surgery for ovarian cancer
- National Cancer Institute — Ovarian epithelial, fallopian tube, and primary peritoneal cancer treatment (PDQ)
- American Cancer Society — Surgery for ovarian cancer
- NHS — Ovarian cancer: treatment
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
What Debulking Surgery Actually RemovesWhere stripping the lining fits in the whole operationHIPEC With Debulking: Who BenefitsThe warmed chemotherapy step some centres add after peritonectomySplenectomy as Part of DebulkingWhy the spleen sometimes has to come out to strip the left sideDrains, Tubes, Lines and CathetersWhat a chest drain is and when it comes outComplications and Red FlagsBreathlessness and other signs that need same-day care
Talk to us
Diaphragm stripping on your consent form?
Send us the CT report or call the helpline. A surgical oncologist will explain what is planned and what to ask the operating team before the day.