RESECTION OF HEPATOCELLULAR-CARCINOMA WITH DIAPHRAGMATIC INVASION

Fourteen consecutive patients with hepatocellular carcinoma (HCC) and diaphragmatic invasion found during operation and confirmed histopatho logically were studied. They were treated by resection of the liver tu mour en bloc with part of the diaphragm. Eight of the 14 patients had a diaphragmatic hump on chest radiography. Preoperative ultrasonograph y, computed tomography and hepatic angiography were unable to diagnose diaphragmatic invasion in these patients. A control group of 14 close ly matched patients were selected from 98 undergoing curative resectio n for HCC during the period of the study. No evidence of a diaphragmat ic hump was found in the control patients (P< 0.001). There was no sig nificant difference in survival, operative morbidity or mortality rate s between the two groups. In patients-with HCC situated in the dome of the liver, the presence of a diaphragmatic hump on chest radiography strongly suggests invasion of the diaphragm. There was no difference i n outcome in patients with or without diaphragmatic invasion; the tumo ur should be resected if the patient is fit for operation.