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

Overview

Journal Ann Surg Oncol

Publisher Springer

Specialty Oncology

Date 2020 Jun 27

PMID 32588266

Citations 2

Authors

Tatsuya Orimo

Toshiya Kamiyama

Kenji Wakayama

Shingo Shimada

Akihisa Nagatsu

Yoh Asahi

Yuzuru Sakamoto

Hirofumi Kamachi

Akinobu Taketomi

Affiliations

Soon will be listed here.

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.

Citing Articles

Diaphragmatic Involvement Should Not Preclude Curative-Intent Surgical Resection for Hepatocellular Carcinoma.

Ejaz A, Pawlik T Ann Surg Oncol. 2020; 27(11):4073-4074.

PMID: 32578064 DOI: 10.1245/s10434-020-08757-3.

ASO Author Reflections: Is Hepatectomy Plus Diaphragmatic Resection for Hepatocellular Carcinoma with Diaphragmatic Involvement Justified?.

Orimo T, Kamiyama T, Taketomi A Ann Surg Oncol. 2020; 27(11):4164-4165.

PMID: 32578063 DOI: 10.1245/s10434-020-08755-5.

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