Gastropleural fistula following advanced stage ovarian cancer interval cytoreductive surgery: A case report and review of the literature.

Introduction: Gastropleural fistula (GPF) is an exceptionally rare complication in oncologic surgery, most often reported after thoracic or abdominal procedures and only sporadically described in ovarian cancer. Case report: We describe a 72-year-old woman with advanced high-grade serous ovarian cancer who underwent interval cytoreductive surgery including bilateral diaphragmatic peritonectomy. Despite achieving optimal cytoreduction (RT 0), her postoperative course was complicated by the onset of dyspnea and hydropneumothorax. A contrast-enhanced CT scan demonstrated a fistulous tract between the gastric fundus and the pleural cavity. She underwent partial gastrectomy, diaphragmatic repair, and thoracic washout, with resolution of the fistula. No adjuvant chemotherapy was given, and disease recurrence occurred after five months, treated with carboplatin plus gemcitabine. Conclusions: This case illustrates that GPF, although extremely uncommon in gynecologic oncology, can occur after extensive diaphragmatic surgery in multimorbid and heavily pre-treated patients. A narrative review of the literature highlights common mechanisms-including tissue ischemia, impaired healing, and oncologic treatments-across both gynecologic and non-gynecologic cases. Early recognition and prompt surgical management are essential for favorable outcomes.