Surgical impacts of an en bloc resection of the diaphragm for XXXX with gross diaphragmatic involvement.

@entity1 @entity157 @entity648 @entity3194
PURPOSE: Diaphragmatic involvement is relatively uncommon in @entity1 undergoing a hepatectomy for @entity157 ( @entity157 ). The aim of this study was to evaluate the short- and long-term surgical impacts of @entity157 with gross diaphragmatic involvement in @entity1 undergoing an en bloc resection of the diaphragm. METHODS: Between 1990 and 2007, 911 @entity1 with @entity157 underwent a hepatectomy at our institution. Twenty-seven @entity1 (3.0%) had had gross involvement of the diaphragm. Thirteen @entity1 (1.4%) had undergone an en bloc resection of the diaphragm, and 14 (1.5%) had received only a blunt dissection. The short-term surgical impacts (surgical morbidity and mortality) and long-term surgical impacts (overall and disease-free survival) were compared between the groups. RESULTS: In @entity1 with an en bloc resection of the diaphragm as compared with those who received a blunt dissection, the values of total @entity648 and the @entity3194 retention rate at 15 min were significantly better (P < 0.01 and P = 0.04, respectively), and the rate of positivity for the hepatitis B antigen was significantly higher (P = 0.02). The positive rates of microscopic fibrocapsular invasion (P = 0.03), microscopic vascular invasion (P = 0.04), and Ki-67 immunostaining (P = 0.04) were significantly higher in @entity1 with an en bloc resection of the diaphragm. There were no significant differences in the short-term and long-term surgical impacts between the groups. CONCLUSION: An en bloc resection of the diaphragm in @entity1 with gross diaphragmatic involvement of @entity157 is therefore justified, since there are no significant differences in short- or long-term surgical impacts in comparison with the @entity1 receiving blunt dissection.
