Surgical impacts of an en bloc resection of the diaphragm for hepatocellular carcinoma with gross diaphragmatic involvement

Yamashita, Yo Ichi; Morita, Kazutoyo; Iguchi, Tomohiro; Tsujita, Eiji; Soejima, Yuji; Taketomi, Akinobu; Maehara, Yoshihiko

doi:10.1007/s00595-010-4289-x

Cited by 18 publications

(25 citation statements)

References 5 publications

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“…Previously, the rate of proven pathological invasions into adjacent organs associated with colorectal liver metastasis has ranged from 15 to 44% (8,24), and the rate of confirmed pathological invasions in this study was within that range. Previous studies have identified several indicators for supporting a preoperative diagnosis of invasion into an adjacent organs (24)(25)(26). Despite recent radiological advances, it remains difficult to evaluate whether a hepatic tumor has invaded an adjacent organ.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcome of extended liver resections for colorectal liver metastasis compared with standard liver resections

et al. 2018

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Abstract. Colorectal liver metastatic lesions sometimes invade adjacent organs. A hepatectomy is often extended to include the involved adjacent organ to achieve negative surgical margins. The purpose of the present retrospective study was to evaluate the surgical outcomes of extended liver resections and patients' prognoses. The medical records of 178 patients with colorectal liver metastasis who underwent liver resections in the Department of Gastroenterological Surgery at Osaka University Hospital (Suita, Japan), from 2000 to 2015 were reviewed. These patients were divided into two groups: the extended resection group (n=20) and the non-extended resection group (n=158). The disease-free and overall survival curves were estimated with the Kaplan-Meier method and analyzed with the log rank test. It was observed that the extended resection group had longer operation times and increased blood loss, however perioperative morbidity was similar. The organs resected most frequently were the diaphragm (n=10) and inferior vena cava (n=5). Overall survival rates in the extended resection group were lower compared with the non-extended resection group (5-year survival rates; 45.0 vs. 67.9%), however the difference was not significant. It was indicated that the aggressive hepatectomy combined with resection of adjacent organs was an acceptable treatment with low perioperative morbidity. The overall survival rate may not be inferior to that of simple hepatectomy.

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Section: Discussionmentioning

confidence: 99%

Surgical outcome of extended liver resections for colorectal liver metastasis compared with standard liver resections

et al. 2018

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“…Although surgical procedures for HCC, such as hepatic resection and liver transplantation, have progressed and the outcomes have improved, HCC is still characterized by frequent recurrence [2][3][4], even after liver transplantation [5]. The recent introduction of the molecular targeting agent, sorafenib, was reported to improve survival rates in patients with nonresectable or advanced HCC [6].…”

Section: Introductionmentioning

confidence: 99%

Role of tumor-associated macrophages in the progression of hepatocellular carcinoma

et al. 2011

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Recent studies have shown that the tumor microenvironment plays an important role in cancer progression. Tumor-associated macrophages (TAMs), in particular, have been found to be associated with tumor progression. Macrophages have multiple biological roles, including antigen presentation, target cell cytotoxicity, removal of foreign bodies, tissue remodeling, regulation of inflammation, induction of immunity, thrombosis, and endocytosis. Recent immunological studies have identified two distinct states of polarized macrophage activation: the classically activated (M1) and the alternatively activated (M2) macrophage phenotypes. Bacterial moieties such as lipopolysaccharides and the Th1 cytokine interferon-γ polarize macrophages toward the M1 phenotype. The M2 polarization was discovered as a response to the Th2 cytokine interleukin-4. In general, M2 macrophages exert immunoregulatory activity, participate in polarized Th2 responses, and aid tumor progression. TAMs have recently been found to play an important role in hepatocellular carcinoma (HCC) progression. Based on the properties of TAMs, obtained from pathological examination of resected specimens, we have identified new therapeutic approaches, involving the targeting of TAMs with adjuvant therapy after hepatic resection for HCC. This review discusses the roles of TAM in HCC progression and the possibility of new therapies targeting TAMs.

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“…Yamashita et al . reported no significant difference in short- or long- term surgical impacts between patients who received en bloc resection and those who had blunt dissection and suggested that surgeons should consider the possibility of tearing the HCC during blunt dissection between the tumor and the diaphragm [20]. Leung et al have reported that a resection margin of 1 cm was the only significant prognostic factor for poor disease-free survival after en bloc resection [21].…”

Section: Discussionmentioning

confidence: 99%

One stage resection of spontaneous rupture of hepatocellular carcinoma in the triangular ligament with diaphragm invasion: case report and review of the literature

2012

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A spontaneous rupture of hepatocellular carcinoma (HCC) can lead to extensive hemorrhage and is a rare but life-threatening event. A 58-year-old male patient with no history of trauma presented at our institution with severe epigastric pain and abdominal distension for 6 h. His blood pressure was a 60/40 mmHg, and pulse rate was 132/min. Abdominal contrast enhanced computed tomography (CT) imaging revealed a ruptured mass under the left diaphragm and fluid collection in the upper abdomen, flanks and pelvic cavity. Exploratory laparotomy confirmed the presence of an active bleeding tumor in the triangular ligament invading into the diaphragm. The tumor was resected with an appropriate diaphragm margin. The resected tumor was 5 cm in diameter and pathologically identified as hepatocellular carcinoma with a negative surgical margin. This case report shows that ruptured hepatocellular carcinoma should be considered in the differential diagnosis of non-traumatic hemoperitoneum. And it is necessary to set a surgical plan for unpredictable HCC rupture with direct diaphragm invasion.

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Surgical impacts of an en bloc resection of the diaphragm for hepatocellular carcinoma with gross diaphragmatic involvement

Abstract: An en bloc resection of the diaphragm in patients with gross diaphragmatic involvement of HCC is therefore justified, since there are no significant differences in short- or long-term surgical impacts in comparison with the patients receiving blunt dissection.

Cited by 18 publications

References 5 publications

Surgical outcome of extended liver resections for colorectal liver metastasis compared with standard liver resections

Surgical outcome of extended liver resections for colorectal liver metastasis compared with standard liver resections

Role of tumor-associated macrophages in the progression of hepatocellular carcinoma

One stage resection of spontaneous rupture of hepatocellular carcinoma in the triangular ligament with diaphragm invasion: case report and review of the literature

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