{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T13:56:58Z","timestamp":1773323818453,"version":"3.50.1"},"reference-count":26,"publisher":"Royal College of Surgeons of England","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2009,9]]},"abstract":"<jats:sec><jats:title>INTRODUCTION<\/jats:title><jats:p> At present, liver resection offers the best long-term outcome and only chance for cure in patients with colorectal liver metastases. However, there are no large series that report the early and long-term outcomes of patients who require simultaneous diaphragm excision. This study was designed to investigate these patients. <\/jats:p><\/jats:sec><jats:sec><jats:title>PATIENTS AND METHODS<\/jats:title><jats:p> A total of 285 consecutive liver resections were performed over a 10-year period. Of these, 258 had liver resections alone and 27 underwent liver resection and simultaneous diaphragm excision. Data were collected prospectively and analysed retrospectively. Pre-operative assessment was standardised. The outcomes between the two groups were compared. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULT<\/jats:title><jats:p> There was no difference in age, hospital stay or intra-operative blood loss. The diaphragm was histologically involved in four out of 27 resections. As a result, the cancer involved resection margin incidence was greater in the liver resection and diaphragm excision group (14.8% versus 3.9%; P = 0.12). The median tumour size was also different between the two groups (60 mm versus 30 mm; P = 0.001). The liver and diaphragm resection group had a greater peri-operative complication rate (44.4% versus 21.3%; P = 0.02) and mortality (7.4% versus 1.6%; P = 0.25). Overall and disease-free survival was significantly worse in the group who underwent simultaneous diaphragm excision and liver resection (P = 0.04 and P = 0.005, respectively). Diaphragm invasion was found to be an independent predictor of poor overall outcome (P = 0.02). <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p> Liver resection and simultaneous diaphragm excision have a greater incidence of peri-operative morbidity and mortality and a significantly worse long-term outcome compared with liver resection alone. However, these data suggest that liver resection in the presence of diaphragm invasion may still offer a favourable outcome compared with chemotherapy treatment alone. Therefore, we believe that diaphragm involvement by tumour should not be a contra-indication to hepatectomy. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2009.91.6.483","type":"journal-article","created":{"date-parts":[[2015,7,27]],"date-time":"2015-07-27T12:23:28Z","timestamp":1437999808000},"page":"483-488","source":"Crossref","is-referenced-by-count":16,"title":["Early and Long-Term Outcomes of Patients Undergoing Liver Resection and Diaphragm Excision for Advanced Colorectal Liver Metastases"],"prefix":"10.1308","volume":"91","author":[{"given":"Jeffrey T","family":"Lordan","sequence":"first","affiliation":[{"name":"Royal Surrey County Hospital Guildford, Surrey, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Riga","sequence":"additional","affiliation":[{"name":"Royal Surrey County Hospital Guildford, Surrey, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim R","family":"Worthington","sequence":"additional","affiliation":[{"name":"Royal Surrey County Hospital Guildford, Surrey, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nariman D","family":"Karanjia","sequence":"additional","affiliation":[{"name":"Royal Surrey County Hospital Guildford, Surrey, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"171","reference":[{"key":"b1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5581"},{"key":"b2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6603033"},{"key":"b3","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19930615)71:12+<4252::AID-CNCR2820711815>3.0.CO;2-6"},{"key":"b4","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800840828"},{"key":"b5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032691"},{"key":"b6","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1994.12.7.1491"},{"key":"b7","doi-asserted-by":"publisher","DOI":"10.1245\/ASO.2005.01.010"},{"key":"b8","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1997.01430290051008"},{"key":"b9","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4429"},{"key":"b10","doi-asserted-by":"publisher","DOI":"10.1245\/ASO.2006.05.039"},{"key":"b11","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1977.1"},{"key":"b12","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200104000-00012"},{"key":"b13","doi-asserted-by":"publisher","DOI":"10.1177\/0885713X9501000108"},{"key":"b14","doi-asserted-by":"publisher","DOI":"10.1016\/S1091-255X(00)80011-6"},{"key":"b15","author":"Karanjia ND","year":"2008","journal-title":"European Journal of Surgical Oncology"},{"key":"b16","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800840719"},{"key":"b17","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.6.1499"},{"key":"b18","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5628"},{"key":"b19","doi-asserted-by":"publisher","DOI":"10.1007\/s001040051345"},{"key":"b20","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60455-9"},{"key":"b21","doi-asserted-by":"publisher","DOI":"10.1002\/jso.21053"},{"key":"b22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa033025"},{"key":"b23","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdl161"},{"key":"b24","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminoncol.2006.08.005"},{"key":"b25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2006.07.005"},{"key":"b26","first-page":"11","volume":"20","author":"Saif MW","year":"2006","journal-title":"Oncology"}],"container-title":["The Annals of The Royal College of Surgeons of England"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/pdf\/10.1308\/rcsann.2009.91.6.483","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T10:02:23Z","timestamp":1684144943000},"score":1,"resource":{"primary":{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/10.1308\/rcsann.2009.91.6.483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,9]]},"references-count":26,"aliases":["10.1308\/003588409x432176"],"journal-issue":{"issue":"6","published-print":{"date-parts":[[2009,9]]}},"alternative-id":["10.1308\/rcsann.2009.91.6.483"],"URL":"https:\/\/doi.org\/10.1308\/rcsann.2009.91.6.483","relation":{},"ISSN":["0035-8843","1478-7083"],"issn-type":[{"value":"0035-8843","type":"print"},{"value":"1478-7083","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,9]]}}}