title: Should diaphragmatic involvement preclude resection of large hepatic tumors?
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.
authors: 4th Department of Surgery, Attikon Hospital, University of Athens Medical School, 1 Rimini Street, 12464 Athens, Greece.
authors: Nikolaos
authors: N
authors: Arkadopoulos
authors: Maria A
authors: MA
authors: Kyriazi
authors: Apostolos
authors: A
authors: Perelas
authors: Kassiani
authors: K
authors: Theodoraki
authors: Evangelia
authors: E
authors: Papantoni
authors: Panagiotis
authors: P
authors: Kokoropoulos
authors: Nikolaos
authors: N
authors: Danias
authors: Vassilios
authors: V
authors: Smyrniotis
mesh_terms: D000328:Adult; D000368:Aged; D000075202:Contraindications; D003964:Diaphragm / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D013536:Suture Techniques
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