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Impact of simultaneous diaphragm resection during hepatectomy for treatment of metastatic colorectal cancer.

Publication ,  Journal Article
Li, GZ; Turley, RS; Lidsky, ME; Barbas, AS; Reddy, SK; Clary, BM
Published in: J Gastrointest Surg
August 2012

INTRODUCTION: For colorectal cancer patients with liver metastases involving the hepatic dome or invading the diaphragm, a concomitant diaphragm resection is often required to achieve negative surgical margins. The purpose of this study is to determine whether diaphragm resection during partial hepatectomy for metastatic colorectal cancer influences short-term perioperative outcomes and overall survival. METHODS: Demographics, treatments, and outcomes of 442 patients who underwent hepatic resection for metastatic colorectal cancer from 1996 to 2010 at a high-volume center were reviewed. Recurrence and survival were measured from the date of metastectomy. Actuarial curves were generated using the Kaplan-Meier method and compared using log-ranks testing. Multivariate predictors of worse survival were compared using a Cox-proportional hazards model. RESULTS: A total of 442 patients underwent hepatectomy for metastatic colorectal cancer. Of these, 34 required simultaneous diaphragm resection (DR) and 408 did not (LR). No significant differences existed in patient demographics or comorbidities. The DR group had longer median operative times (336 vs. 267 min, p = 0.0008) but had comparable rates of perioperative morbidity and mortality. Median overall survival was shorter in the DR group compared to the LR group (18.8 vs. 36 months, p = 0.0017). When controlling for potential cofounders, liver metastases size > 5 cm (HR 1.45 95 % CI (1.08-1.99), p = 0.015) and diaphragm resection (HR = 1.72 95 % CI (1.03-2.86), p = 0.038) predicted worse survival. CONCLUSIONS: Simultaneous diaphragm resection during partial hepatectomy does not significantly influence perioperative morbidity or mortality despite longer operative times. However, patients who require diaphragm resection have less favorable survival rates as compared to those who do not.

Duke Scholars

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

August 2012

Volume

16

Issue

8

Start / End Page

1508 / 1515

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Surgery
  • Retrospective Studies
  • Postoperative Complications
  • Operative Time
  • Neoplasm Recurrence, Local
  • Neoplasm Metastasis
  • Muscle Neoplasms
  • Multivariate Analysis
 

Citation

APA
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ICMJE
MLA
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Li, G. Z., Turley, R. S., Lidsky, M. E., Barbas, A. S., Reddy, S. K., & Clary, B. M. (2012). Impact of simultaneous diaphragm resection during hepatectomy for treatment of metastatic colorectal cancer. J Gastrointest Surg, 16(8), 1508–1515. https://doi.org/10.1007/s11605-012-1896-4
Li, George Z., Ryan S. Turley, Michael E. Lidsky, Andrew S. Barbas, Srinevas K. Reddy, and Bryan M. Clary. “Impact of simultaneous diaphragm resection during hepatectomy for treatment of metastatic colorectal cancer.J Gastrointest Surg 16, no. 8 (August 2012): 1508–15. https://doi.org/10.1007/s11605-012-1896-4.
Li GZ, Turley RS, Lidsky ME, Barbas AS, Reddy SK, Clary BM. Impact of simultaneous diaphragm resection during hepatectomy for treatment of metastatic colorectal cancer. J Gastrointest Surg. 2012 Aug;16(8):1508–15.
Li, George Z., et al. “Impact of simultaneous diaphragm resection during hepatectomy for treatment of metastatic colorectal cancer.J Gastrointest Surg, vol. 16, no. 8, Aug. 2012, pp. 1508–15. Pubmed, doi:10.1007/s11605-012-1896-4.
Li GZ, Turley RS, Lidsky ME, Barbas AS, Reddy SK, Clary BM. Impact of simultaneous diaphragm resection during hepatectomy for treatment of metastatic colorectal cancer. J Gastrointest Surg. 2012 Aug;16(8):1508–1515.
Journal cover image

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

August 2012

Volume

16

Issue

8

Start / End Page

1508 / 1515

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Surgery
  • Retrospective Studies
  • Postoperative Complications
  • Operative Time
  • Neoplasm Recurrence, Local
  • Neoplasm Metastasis
  • Muscle Neoplasms
  • Multivariate Analysis