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Comparative Study
. 2014 Nov;156(5):1197-203.
doi: 10.1016/j.surg.2014.04.050. Epub 2014 Jun 20.

Simultaneous lung resection via a transdiaphragmatic approach in patients undergoing liver resection for synchronous liver and lung metastases

Yoshihiro Mise  1 , Reza J Mehran  2 , Thomas A Aloia  1 , Jean-Nicolas Vauthey  3
Affiliations
Comparative Study

Simultaneous lung resection via a transdiaphragmatic approach in patients undergoing liver resection for synchronous liver and lung metastases

Yoshihiro Mise et al. Surgery. 2014 Nov.

Abstract

Background: For patients with synchronous liver and lung metastases from colorectal cancer, the invasiveness of adding thoracic to abdominal surgery is an obstacle to concurrent liver and lung metastasectomy. We developed a simple technique to resect lung lesions via a transdiaphragmatic approach without thoracic incision in patients undergoing liver metastasectomy.

Methods: Sixteen patients with synchronous liver and unilateral lung metastases underwent transdiaphragmatic wedge resection of lung lesions simultaneous with liver metastasectomy. Short-term operative outcomes were compared with those in 102 patients treated with conventional unilateral wedge resection for colorectal lung metastases.

Results: Twenty peripheral (<3 cm from the pleura) lung lesions from various locations in the lung were resected via transdiaphragmatic approach. No conversions to conventional approach were required. The median tumor number and size were 1 (range, 1-3) and 8 mm (range, 3-30 mm), respectively. Transdiaphragmatic resection reduced median operative blood loss compared with conventional resection (0 mL vs 50 mL [P < .001]) and reduced median duration of hospital stay compared with staged liver and lung resection (6 days vs 11 days [P < .001]). Operative duration and rates of lung-related morbidity and positive surgical margin were similar between the transdiaphragmatic and conventional groups (104 minutes vs 105 minutes [P = .61], 13% vs 4% [P = .15], and 6% vs 5% [P = .73], respectively).

Conclusion: Simultaneous transdiaphragmatic resection of peripheral lung lesions is safe in patients undergoing liver resection. The low-invasive transdiaphragmatic approach facilitates aggressive operative treatment for synchronous liver and lung metastases.

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Figures

Figure 1
Figure 1. Location of 20 Lung Lesions
Locations of lesions resected by simultaneous transdiaphragmatic lung metastasectomy in patients undergoing resection of liver metastases. Bold numbers indicate the number of lesions resected in each lung lobe. Numbers in parentheses indicate mean diameter of tumors (mm) and mean distance from the pleura to tumors (mm), respectively.
See this image and copyright information in PMC

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