Transdiaphragmatic approach facilitates resection of large (>12 cm) liver tumors.

Background/purpose: Various (mostly transthoracic) techniques have been proposed to facilitate access to large tumors located in the upper part of the liver, close to the confluence of the major hepatic veins. The purpose of this study was to investigate the safety and efficacy of a transdiaphragmatic mobilization technique for resection of such tumors.

Methods: Twenty-one patients, with tumors ranging from 12 to 22 cm in diameter, underwent liver resections using our technique of diaphragmatic splitting, with the intention of achieving adequate exposure of the inferior vena cava and the hepatocaval junction.

Results: The technique described provided, in all patients, an effective method to achieve the vascular control required for a safe liver resection. Median weight of the excised tumors was 1100 g (range, 817-2860 g).

Conclusions: Large liver tumors (>12 cm) in the upper part of the liver may be approached through a standard bilateral subcostal incision, combined with splitting of the hemidiaphragm, without the need for any kind of thoracic incision.