Transthoracic Approach (TTA) for Subdiaphragmatic
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Spiros G. Delis1, Andreas Bakoyiannis1,
Juan Madariaga2, Nikos Tassopoulos1, Ch.
1)Liver Surgical Unit, 1st Surgical Department , "Agia Olga"
Hospital, Athens, Greece.
2) Department of Surgery, Division of Transplantation, University
of Miami School of Medicine, Miami, Florida, USA
Background. Hepatic and pulmonary recurrences
are major determinants of survival for patients who have undergone
curative resection of colorectal carcinoma. In a selected group
of patients, resection of metachronous, liver and lung metastases
prolongs survival despite the aggressive nature of these lesions.
The experience from an exclusive transthoracic, transdiaphragmatic
approach (TTA) is limited. We present our experience with metastasectomy
in patients with metachronous liver and right lung metastases,
in whom an exclusive transthoracic approach was performed.
Methods. Between 2002 and 2007, seven patients
with metachronous colorectal liver and right-lung metastases,
underwent an exclusive transthoracic approach. There were five
men and two women, with a median age of 69 years (range 55 to
78 years). Liver resections performed included segmentectomy of
segments VII, VIII, or both. Previous operations, including colon
resection, adhesiolysis, ventral hernia repair, or transabdominal
segment V resection, were performed in all patients.
Results. No peri-operative mortality was documented.
Morbidity included pleural effusion (n=3) and post-operative pneumonia
(n=1), which responded to conservative management. Median hospital
stay was 8 days (range 5-12 days). With a median follow-up of
31 months, one patient died of generalized disease.
Conclusion. The factors that led to the increase
of performances in colonoscopy in our department were the use
of proper sedation and analgesia, the permanent internal audit
of the maneuver, as well as the motivation of the endoscopist
to obtain good results.
Colorectal carcinoma - liver metastases - lung metastases; diaphragmatic
plication - TTA