En bloc resection of diaphragm and liver tumours: An effective technique of diaphragmatic repair avoiding routine intercostal drain

Abstract

Introduction: Surgical resection remains the mainstay of treatment for hepatic malignancies. The presence of contiguous involvement of adjacent organs is considered only as relative contraindications provided complete tumour extirpation is achieved. We describe a simple technique of primary diaphragmatic repair post-en bloc resection of diaphragm and liver tumours. The aim of this study was to evaluate the effectiveness of the surgical technique. Methods: Between January 2007 and June 2015, 515 patients with liver tumours were treated by a single surgeon (K.S.H) at the Prince of Wales and St Vincent's (Public and Private) Hospitals. Thirteen patients were identified with diaphragmatic adherence intraoperatively and were surgically treated with en bloc resection. Diaphragmatic repair was performed without use of an intercostal catheter (ICC). Chest Xrays were performed at day-0 and day-1 post-surgery. The post-surgical morbidities and mortalities in these 13 patients were analysed. Results: One patient developed pleural effusion requiring ICC insertion. Only 1 of 11 patients with malignant liver lesions had true tumour invasion of the diaphragm on histopathological analysis. There were no perioperative mortalities. Amongst the patients with hepatic malignancies treated, the median survival was 27.7 months (range, 1.5 – 39.4 months) and the estimated 5-year overall survival was 48.6%. Conclusion: The described technique of primary diaphragmatic repair is safe and effective at achieving R0 resection margin when threatened by tumour adherent to diaphragm.