Transthoracic approach (TTA) for subdiaphragmatic liver metastasectomy

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. 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. 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. 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.