title: Simultaneous lung resection via a transdiaphragmatic approach in patients undergoing liver resection for synchronous liver and lung metastases.
abstract: BACKGROUND
  For patients with synchronous liver and lung metastases from colorectal cancer, the invasiveness of adding thoracic to abdominal surgery is an obstacle to concurrent liver and lung metastasectomy. We developed a simple technique to resect lung lesions via a transdiaphragmatic approach without thoracic incision in patients undergoing liver metastasectomy.
  
  
  METHODS
  Sixteen patients with synchronous liver and unilateral lung metastases underwent transdiaphragmatic wedge resection of lung lesions simultaneous with liver metastasectomy. Short-term operative outcomes were compared with those in 102 patients treated with conventional unilateral wedge resection for colorectal lung metastases.
  
  
  RESULTS
  Twenty peripheral (<3 cm from the pleura) lung lesions from various locations in the lung were resected via transdiaphragmatic approach. No conversions to conventional approach were required. The median tumor number and size were 1 (range, 1-3) and 8 mm (range, 3-30 mm), respectively. Transdiaphragmatic resection reduced median operative blood loss compared with conventional resection (0 mL vs 50 mL [P < .001]) and reduced median duration of hospital stay compared with staged liver and lung resection (6 days vs 11 days [P < .001]). Operative duration and rates of lung-related morbidity and positive surgical margin were similar between the transdiaphragmatic and conventional groups (104 minutes vs 105 minutes [P = .61], 13% vs 4% [P = .15], and 6% vs 5% [P = .73], respectively).
  
  
  CONCLUSIONS
  Simultaneous transdiaphragmatic resection of peripheral lung lesions is safe in patients undergoing liver resection. The low-invasive transdiaphragmatic approach facilitates aggressive operative treatment for synchronous liver and lung metastases.
authors: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Yoshihiro
authors: Y
authors: Mise
authors: Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Reza J
authors: RJ
authors: Mehran
authors: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Thomas A
authors: TA
authors: Aloia
authors: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: jvauthey@mdanderson.org.
authors: Jean-Nicolas
authors: JN
authors: Vauthey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology; D003964:Diaphragm / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008168:Lung / Q000473:pathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies