Skip to main content

Advertisement

SpringerLink
Log in

Should Diaphragmatic Involvement Preclude Resection of Large Hepatic Tumors?

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Treatment of peripherally located liver tumors with diaphragmatic invasion is technically demanding but does not preclude resection for cure. The aim of the present study was to compare patients undergoing combined liver and diaphragmatic resection with those submitted to hepatectomy alone so as to evaluate the safety, effectiveness, and value of this complex surgical procedure.

Methods

From January 2000 to September 2011, 36 consecutive patients underwent en bloc liver-diaphragm resection (group A). These were individually matched for age, gender, tumor size, pathology, and co-morbitidies with 36 patients who underwent hepatectomy alone during the same time (group B). Operative time, warm ischemia time, blood loss, required transfusions, postoperative complications, and long-term survival were evaluated.

Results

Mean operative time was significantly longer in group A than in group B (165 vs 142 min; P = 0.004). The two groups were comparable regarding warm ischemia time, intraoperative blood loss, required transfusions, and postoperative laboratory value fluctuations. Some 33 % of group A patients developed complications postoperatively as opposed to 23 % of group B patients (P = 0.03). The mortality rate was 2.8 % in group A compared to 0 % in group B. Postoperative follow-up demonstrated 60 % 1-year survival for group A patients as opposed to 80 % 1-year survival for group B patients, a difference that is practically eliminated the longer the follow-up period is extended (35 vs 40 % 3-year survival and 33 vs 37 % 5-year survival for group A and group B patients, respectively).

Conclusions

En bloc diaphragmatic and liver resection is a challenging but safe surgical procedure that is fully justified when diaphragmatic infiltration cannot be ruled out and the patient is considered fit enough to undergo surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. DuBray BJ Jr, Chapman WC, Anderson CD (2011) Hepatocellular carcinoma: a review of the surgical approaches to management. Mo Med 108:195–198

    PubMed  Google Scholar 

  2. Karoui M, Tayar C, Laurent A et al (2007) En bloc stapled diaphragmatic resection for local invasion during hepatectomy: a simple technique without opening the pleural cavity. Am J Surg 193:786–788

    Article  PubMed  Google Scholar 

  3. Elias D, Sideris L, Pocard M et al (2004) Results of R0 resection for colorectal liver metastases associated with extrahepatic disease. Ann Surg Oncol 11:274–280

    Article  PubMed  Google Scholar 

  4. Lin MC, Wu CC, Chen JT et al (2005) Surgical results of hepatic resection for hepatocellular carcinoma with gross diaphragmatic invasion. Hepatogastroenterology 52:1497–1501

    PubMed  Google Scholar 

  5. Yamashita Y, Morita K, Iguchi T et al (2011) Surgical impacts of an en bloc resection of the diaphragm for hepatocellular carcinoma with gross diaphragmatic involvement. Surg Today 41:101–106

    Article  PubMed  Google Scholar 

  6. Smyrniotis V, Arkadopoulos N, Theodosopoulos T et al (2007) Transdiaphragmatic approach facilitates resection of large (>12 cm) liver tumors. J Hepatobiliary Pancreat Surg 14:383–386

    Article  PubMed  Google Scholar 

  7. Smyrniotis V, Farantos C, Kostopanagiotou G et al (2005) Vascular control during hepatectomy: review of methods and results. World J Surg 29:1384–1396. doi:10.1007/s00268-005-0025-x

    Article  PubMed  Google Scholar 

  8. Lau WY, Leung KL, Leung TW et al (1995) Resection of hepatocellular carcinoma with diaphragmatic invasion. Br J Surg 82:264–266

    Article  PubMed  CAS  Google Scholar 

  9. Leung KF, Chui AK, Leung KL et al (2001) Clinicopathological study of hepatocellular carcinoma with diaphragmatic involvement. Br J Surg 88:681–682

    Article  PubMed  CAS  Google Scholar 

  10. Lordan JT, Riga A, Worthington TR et al (2009) Early and long-term outcomes of patients undergoing liver resection and diaphragm excision for advanced colorectal liver metastases. Ann R Coll Surg Engl 91:483–488

    Article  PubMed  Google Scholar 

  11. Tung WY, Chau GY, Loong CC et al (1996) Surgical resection of primary hepatocellular carcinoma extending to adjacent organ(s). Eur J Surg Oncol 22:516–520

    Article  PubMed  CAS  Google Scholar 

  12. Jeng KS, Chen BF, Lin HJ (1994) En bloc resection for extensive hepatocellular carcinoma: is it advisable? World J Surg 18:834–839. doi:10.1007/BF00299079

    Article  PubMed  CAS  Google Scholar 

  13. Li GZ, Turley RS, Lidsky ME et al (2012) Impact of simultaneous diaphragm resection during hepatectomy for treatment of metastatic colorectal cancer. J Gastrointest Surg 16:1508–1515

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. 4th Department of Surgery, Attikon Hospital, University of Athens Medical School, 1 Rimini Street, 12464, Athens, Greece

    Nikolaos Arkadopoulos, Maria A. Kyriazi, Apostolos Perelas, Evangelia Papantoni, Panagiotis Kokoropoulos, Nikolaos Danias & Vassilios Smyrniotis

  2. 1st Department of Anesthesiology, Areteion Hospital, University of Athens Medical School, Athens, Greece

    Kassiani Theodoraki

Authors
  1. Nikolaos Arkadopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria A. Kyriazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Apostolos Perelas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kassiani Theodoraki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Evangelia Papantoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Panagiotis Kokoropoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nikolaos Danias
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vassilios Smyrniotis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria A. Kyriazi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arkadopoulos, N., Kyriazi, M.A., Perelas, A. et al. Should Diaphragmatic Involvement Preclude Resection of Large Hepatic Tumors?. World J Surg 37, 2197–2201 (2013). https://doi.org/10.1007/s00268-013-2083-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-013-2083-9

Keywords

Search

Navigation