Hepatectomy Combined with Diaphragmatic Resection for Hepatocellular Carcinoma with Diaphragmatic Involvement: A Propens
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Hepatectomy Combined with Diaphragmatic Resection for Hepatocellular Carcinoma with Diaphragmatic Involvement: A Propensity Score-Matched Analysis Tatsuya Orimo, MD, PhD1, Toshiya Kamiyama, MD, PhD, FACS1, Kenji Wakayama, MD, PhD2, Shingo Shimada, MD, PhD1, Akihisa Nagatsu, MD1, Yoh Asahi, MD1, Yuzuru Sakamoto, MD1, Hirofumi Kamachi, MD, PhD1, and Akinobu Taketomi, MD, PhD, FACS1 1
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan; 2Department of Surgery, Hokkaido Prefectural Welfare Federation of Agricultural Cooperative (P.W.F.A.C.) Sapporo Kosei General Hospital, Sapporo, Japan
ABSTRACT Purpose. We evaluated the short- and long-term surgical outcomes of hepatectomy combined with diaphragmatic resection for hepatocellular carcinoma (HCC) with diaphragmatic involvement. Methods. We retrospectively reviewed the surgical outcomes of HCC patients with diaphragmatic resection (DR group) and HCC patients without diaphragmatic resection (non-DR group). We applied 1:1 propensity score matching (PSM) to these subjects. Results. The study included 46 patients in DR group and 828 patients in non-DR group. The DR group cases were pathologically more advanced, and both overall and relapse-free survival among the patients in this group with pathological diaphragmatic invasion were similar to cases with pathological diaphragmatic fibrous adhesion. There were 40 patients from each group subjected to PSM. In these matched cohorts, there was no statistically significant difference between the two groups regarding perioperative outcomes, overall survival, and relapse-free survival. Multivariate analyses of our matched HCC patients revealed that alpha-fetoprotein expression and tumor size were independent prognostic factors for overall survival and poor differentiation for relapse-free survival, whereas neither diaphragmatic invasion nor diaphragmatic resection
Ó Society of Surgical Oncology 2020 First Received: 19 February 2020 T. Orimo, MD, PhD e-mail: [email protected]
were prognostic indicators. The most frequent site of recurrence in non-DR group was the liver, whereas the most frequent site of recurrence in DR group was the lung before and after PSM. Conclusions. The short- and long-term surgical outcomes of DR HCC cases are equivalent to their non-DR counterparts under a matched clinicopathological background. Hepatectomy combined with DR is an acceptable treatment for HCC with either diaphragmatic fibrous adhesion or diaphragmatic invasion.
Hepatocellular carcinoma (HCC) is the most frequently occurring primary liver cancer and is ranked as the sixth most common neoplasm and the third leading cause of cancer death worldwide.1 Several factors are known to affect the prognosis of HCC, including alpha-fetoprotein (AFP), portal vein invasion, and tumor size.1–3 On the other hand, the impact of diaphragmatic invasion on the prognosis in HCC is still unclear due to its rarity. Hepatic resection is the establishe
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