title: Impact of simultaneous diaphragm resection during hepatectomy for treatment of metastatic colorectal cancer.
abstract: BACKGROUND
  For colorectal cancer patients with liver metastases involving the hepatic dome or invading the diaphragm, a concomitant diaphragm resection is often required to achieve negative surgical margins. The purpose of this study is to determine whether diaphragm resection during partial hepatectomy for metastatic colorectal cancer influences short-term perioperative outcomes and overall survival.
  
  
  METHODS
  Demographics, treatments, and outcomes of 442 patients who underwent hepatic resection for metastatic colorectal cancer from 1996 to 2010 at a high-volume center were reviewed. Recurrence and survival were measured from the date of metastectomy. Actuarial curves were generated using the Kaplan-Meier method and compared using log-ranks testing. Multivariate predictors of worse survival were compared using a Cox-proportional hazards model.
  
  
  RESULTS
  A total of 442 patients underwent hepatectomy for metastatic colorectal cancer. Of these, 34 required simultaneous diaphragm resection (DR) and 408 did not (LR). No significant differences existed in patient demographics or comorbidities. The DR group had longer median operative times (336 vs. 267 min, p = 0.0008) but had comparable rates of perioperative morbidity and mortality. Median overall survival was shorter in the DR group compared to the LR group (18.8 vs. 36 months, p = 0.0017). When controlling for potential cofounders, liver metastases size > 5 cm (HR 1.45 95 % CI (1.08-1.99), p = 0.015) and diaphragm resection (HR = 1.72 95 % CI (1.03-2.86), p = 0.038) predicted worse survival.
  
  
  CONCLUSIONS
  Simultaneous diaphragm resection during partial hepatectomy does not significantly influence perioperative morbidity or mortality despite longer operative times. However, patients who require diaphragm resection have less favorable survival rates as compared to those who do not.
authors: School of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors: George Z
authors: GZ
authors: Li
authors: Ryan S
authors: RS
authors: Turley
authors: Michael E
authors: ME
authors: Lidsky
authors: Andrew S
authors: AS
authors: Barbas
authors: Srinevas K
authors: SK
authors: Reddy
authors: Bryan M
authors: BM
authors: Clary
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D003964:Diaphragm / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019042:Muscle Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome