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Hepatectomy Combined with Diaphragmatic Resection for Hepatocellular Carcinoma with Diaphragmatic Involvement: A Propensity Score-Matched Analysis

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

We evaluated the short- and long-term surgical outcomes of hepatectomy combined with diaphragmatic resection for hepatocellular carcinoma (HCC) with diaphragmatic involvement.

Methods

We retrospectively reviewed the surgical outcomes of HCC patients with diaphragmatic resection (DR group) and HCC patients without diaphragmatic resection (non-DR group). We applied 1:1 propensity score matching (PSM) to these subjects.

Results

The study included 46 patients in DR group and 828 patients in non-DR group. The DR group cases were pathologically more advanced, and both overall and relapse-free survival among the patients in this group with pathological diaphragmatic invasion were similar to cases with pathological diaphragmatic fibrous adhesion. There were 40 patients from each group subjected to PSM. In these matched cohorts, there was no statistically significant difference between the two groups regarding perioperative outcomes, overall survival, and relapse-free survival. Multivariate analyses of our matched HCC patients revealed that alpha-fetoprotein expression and tumor size were independent prognostic factors for overall survival and poor differentiation for relapse-free survival, whereas neither diaphragmatic invasion nor diaphragmatic resection were prognostic indicators. The most frequent site of recurrence in non-DR group was the liver, whereas the most frequent site of recurrence in DR group was the lung before and after PSM.

Conclusions

The short- and long-term surgical outcomes of DR HCC cases are equivalent to their non-DR counterparts under a matched clinicopathological background. Hepatectomy combined with DR is an acceptable treatment for HCC with either diaphragmatic fibrous adhesion or diaphragmatic invasion.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan

    Tatsuya Orimo MD, PhD, Toshiya Kamiyama MD, PhD, FACS, Shingo Shimada MD, PhD, Akihisa Nagatsu MD, Yoh Asahi MD, Yuzuru Sakamoto MD, Hirofumi Kamachi MD, PhD & Akinobu Taketomi MD, PhD, FACS

  2. Department of Surgery, Hokkaido Prefectural Welfare Federation of Agricultural Cooperative (P.W.F.A.C.) Sapporo Kosei General Hospital, Sapporo, Japan

    Kenji Wakayama MD, PhD

Authors
  1. Tatsuya Orimo MD, PhD
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  2. Toshiya Kamiyama MD, PhD, FACS
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  3. Kenji Wakayama MD, PhD
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  4. Shingo Shimada MD, PhD
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  5. Akihisa Nagatsu MD
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  6. Yoh Asahi MD
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  7. Yuzuru Sakamoto MD
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  8. Hirofumi Kamachi MD, PhD
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  9. Akinobu Taketomi MD, PhD, FACS
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Correspondence to Tatsuya Orimo MD, PhD.

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Orimo, T., Kamiyama, T., Wakayama, K. et al. Hepatectomy Combined with Diaphragmatic Resection for Hepatocellular Carcinoma with Diaphragmatic Involvement: A Propensity Score-Matched Analysis. Ann Surg Oncol 27, 4153–4163 (2020). https://doi.org/10.1245/s10434-020-08754-6

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  • DOI: https://doi.org/10.1245/s10434-020-08754-6

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