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[Extended liver resection in small children under circulatory arrest and "low-flow" cardiopulmonary bypass]
K J Oldhafer1, J Fuchs, G Steinhoff
1Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover. karl.oldhafer@uni-essen.de
Insights
Liver resections using cardiopulmonary bypass in children with hepatoblastoma are feasible and well-tolerated. This technique enables complex tumor removal, leading to promising long-term outcomes with chemotherapy.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Cardiopulmonary Bypass
Background:
- Liver resections in children with critical site tumors are challenging.
- Cardiopulmonary bypass with deep hypothermia allows for complex liver tumor resections.
Observation:
- Three pediatric hepatoblastoma cases underwent liver resection under cardiopulmonary bypass.
- One patient had cardiac arrest, while two had "low flow" conditions.
- Procedures involved extended right liver resections with vascular reconstructions.
Findings:
- Cardiopulmonary bypass was well-tolerated in all patients.
- Postoperative liver enzymes showed moderate increases (GOT 100-200 U/l).
- Two patients achieved long-term tumor-free survival (8 years and 10 months).
Implications:
- Liver resection under cardiopulmonary bypass is a viable option for pediatric hepatoblastoma.
- This approach facilitates complete tumor removal and improved survival rates.
- Multidisciplinary treatment including chemotherapy is crucial for long-term success.
Abstract:
In order to perform resections of tumors at critical sites in the liver in young children, liver resections in cardiac arrest and deep hypothermia under cardiopulmonary bypass have been developed. We report our experience with liver resection under cardiopulmonary bypass in three children with hepatoblastoma. In the first child the operation was performed under cardiac arrest and, the other two children were operated on under "low flow" conditions. The periods under cardiopulmonary bypass circulation were well tolerated. Extended right liver resections with vascular reconstructions were performed. The postoperative increase of liver enzymes was moderate. The increase in GOT was between 100 and 200 U/l. In spite of the extended tumor growth, reasonable long-term results were achieved by resection in combination with chemotherapy. One child has been living 8 years and another 10 months without tumor recurrence. The third child died due to sepsis during adjuvant chemotherapy, after she had recovered well from liver resection.