155P - Combination of hepatic surgery and minimally invasive thoracic surgery using a subxyphoid approach through an abdominal incision

Date 07 May 2017
Event ELCC 2017
Session Poster Display Session
Topics Thoracic Malignancies
Surgical Oncology
Therapy
Radiation Oncology
Presenter MIHEE Lim
Citation Annals of Oncology (2017) 28 (suppl_2): ii52-ii55. 10.1093/annonc/mdx094
Authors M. Lim, D.H. Kim
  • Department Of Cardiovascular And Thoracic Surgery, Research Institute For Convergence Of Biomedical Science And Technology, Pusan National University Yangsan Hospital, Pusan National University Yangsan Hospital, 50612 - Yangsan/KR

Abstract

Background

If an intrathoracic mass is found in a patient scheduled for open hepatic surgery, combined surgery is not recommended because of the high risk. If combined surgery is essential, the thoracic approach must be minimally invasive. We here introduce a subxyphoid approach through an abdominal incision to minimize the invasiveness of combined thoracic and hepatic surgery.

Methods

From April 2012 to December 2016, 17 patients requiring combined hepatic and thoracic surgery were treated via the subxyphoid approach through an abdominal incision. We retrospectively analyzed the clinical data and evaluated the feasibility of the procedure.

Results

The hepatic lesions included 7 cases (41.2%) of colon cancer metastases and 10 cases (58.8%) of primary hepatocellular carcinoma. The types of liver resection performed included two wedge resections (11.8%), two multiple wedge resections (11.8%), eight segmentectomies (47.1%), three lobectomies (17.5%), and two other procedures (11.8%). Unilateral, mediastinal, and bilateral subxyphoid approaches toward thoracic surgery were employed in 11 (64.7%), 2 (11.8%), and 4 (23.5%) cases, respectively. The thoracic surgeries included six cases (35.3%) of wedge resection, five cases (29.4%) of multiple wedge resection, two (11.8%) segmentectomies, and four (23.5%) mediastinal mass excisions. The mean number of lung masses excised was 1.7±1.0 (range 1–5). No lung-related morbidities were noted; one patient died as a result of the abdominal procedure. The mean thoracic and total operation times were 79.7±63.0 min (range, 20–205 min) and 411.0±109.0 min (range, 255–635 min), respectively. Mean ICU and mean hospital stay did not differ between the patients described above and others who underwent open hepatic surgery during the same period.

Conclusions

The subxyphoid approach through an abdominal incision allows aggressive treatment of intrathoracic masses in patients scheduled for open hepatic surgery. This approach did not have a significant impact on the time of operation and the period of the recovery. The approach is especially suitable for patients with bilateral lung lesions.

Clinical trial identification

Legal entity responsible for the study

Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital

Funding

Department of Cardiovascular and Thoracic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital

Disclosure

All authors have declared no conflicts of interest.