Hepatocellular carcinoma with en bloc diaphragmatic resection: A single-center experience over 14 years

Abstract

En bloc resection of diaphragm was associated with acceptable morbidity and mortality, and there was no difference in OS and DFS between HCC patients with DI or DFA. Therefore, it would be advisable to perform en bloc diaphragmatic resection when HCC patients present with gross diaphragmatic involvement.

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

“…Diaphragmatic invasion by a HCC is not uncommon and does not exclude the possibility of a curative surgery. There are however few published data that indicate whether the increased risks involved in diaphragmatic resection are worth taking, other than a few studies [4,5,7,10]. Yuki et al have reported a direct diaphragmatic involvement in 10%-13% of HCC patients according to autopsy results [11].…”

“…HCC with diaphragmatic involvement includes both cases of diaphragmatic fibrous adhesion without pathological invasion and pathological diaphragmatic invasion [7].…”

“…Ultrasonography, CT, and hepatic angiography modalities are also not useful for making a preoperative diagnosis of pathological diaphragmatic invasion in a HCC patient and whilst chest radiography and magnetic resonance imaging may help to evaluate diaphragmatic involvement, they cannot identify invasion of the diaphragm by the tumor. Thus, a postoperative pathological diagnosis is the only method available to confirm pathological diaphragmatic invasion [7]. Among HCC patients with diaphragmatic involvement, the reported percentage of cases with pathological diaphragmatic invasion has been low.…”

“…Thus, when a HCC tumor is suspected to have infiltrated the diaphragm, a hepatectomy combined with an en bloc resection of the diaphragm is thought to be important to avoid such intraoperative bleeding risk or tumor rupture. Several reports have justified this type of surgery [4][5][6][7]. However, although infiltration of the diaphragm of HCC is common in advanced cases, such as those harboring very large tumors, there has been no prior study that has matched the clincopathological background of these patients and this has caused a selection bias.…”

The upregulation of microRNA-223 promoted the apoptosis of liver cancer cells via TLR4

“…Despite operative excision being the first priority in LC therapy, common postoperative relapse is an intractable challenge (Huang et al 2018;Zhao et al 2018). Furthermore, response of LC to chemotherapy is limited (Liu et al 2018;Tokumitsu et al 2018). There is also insufficient investigation on the etiology of LC generation.…”