title: Laparoscopic right hepatectomy combined with partial diaphragmatic resection for colorectal liver metastases: Is it feasible and reasonable?
abstract: BACKGROUND
  The impact of diaphragmatic invasion in patients with colorectal liver metastases (CRLMs) remains poorly evaluated. We aimed to evaluate feasibility and safety of laparoscopic right hepatectomy (LRH) with or without diaphragmatic resection for CRLM.
  
  
  METHODS
  From 2002 to 2012, 52 patients underwent LRH for CRLM. Of them, 7 patients had combined laparoscopic partial diaphragmatic resection ("diaphragm" group). Data were retrospectively collected and short and long-term outcomes analyzed.
  
  
  RESULTS
  Operative time was lower in the control group (272 vs 345 min, P = .06). Six patients required conversion to open surgery. Blood loss and transfusion rate were similar. Portal triad clamping was used more frequently in the "diaphragm" group (42.8% vs 6.6%, P = .02). Maximum tumor size was greater in the "diaphragm" group (74.5 vs 37.1 mm, P = .002). Resection margin was negative in all cases. Mortality was nil and general morbidity similar in the 2 groups. Specific liver-related complications occurred in 2 patients in the "diaphragm" group and 17 in the control group (P = .69). Mean hospital stay was similar (P = 56). Twenty-two (42.3%) patients experienced recurrence. One-, 3-, and 5-year overall survival after surgery in "diaphragm" and control groups were 69%, 34%, 34%, and 97%, 83%, 59%, respectively (P = .103). One- and 3-year disease-free survival after surgery in "diaphragm" and control groups were 57%, 47% and 75%, 54%, respectively (P = .310).
  
  
  CONCLUSIONS
  LRH with en-bloc diaphragmatic resection could be reasonably performed for selected patients in expert centers. Technical difficulties related to diaphragmatic invasion must be circumvented. Further experience must be gained to confirm our results.
authors: Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France.
authors: Panagiotis
authors: P
authors: Lainas
authors: Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France.
authors: Antoine
authors: A
authors: Camerlo
authors: Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Claudius
authors: C
authors: Conrad
authors: Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France.
authors: Nayruthia
authors: N
authors: Shivathirthan
authors: Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France.
authors: David
authors: D
authors: Fuks
authors: Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France. Electronic address: brice.gayet@imm.fr.
authors: Brice
authors: B
authors: Gayet
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D003964:Diaphragm / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016896:Treatment Outcome