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Is a modified central bisegmentectomy a volume-saving operation for pediatric hepatoblastoma?
Yasuharu Ohno1, Junichiro Furui, Takashi Kanematsu
1Division of Pediatric Surgery, Department of Surgery, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.
Journal of Pediatric Surgery
|December 25, 2003
Summary
A modified central bisegmentectomy offers a volume-saving approach for pediatric hepatoblastoma, preserving 87% of liver parenchyma. This technique is a valuable alternative to minimize morbidity and mortality in liver tumor surgery.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Hepatoblastoma is a primary malignant liver tumor in children.
- Centrally located tumors pose surgical challenges, often requiring extensive liver resection.
- Minimizing resection volume is crucial for preserving liver function and reducing postoperative complications.
Observation:
- An 11-month-old girl presented with hepatoblastoma involving Couinaud's segments IV, V, VII, and VIII.
- Adjuvant chemotherapy resulted in a partial response, with residual tumor in segments IV and VIII.
- A modified central bisegmentectomy was performed, resecting segments IV, VIII, and part of V.
Findings:
- Volumetric analysis estimated 87% of functioning liver parenchyma was preserved after the modified central bisegmentectomy.
- In contrast, a right trisegmentectomy would have preserved only 44% of the liver volume.
- The postoperative course was uneventful, with the patient remaining well 22 months post-operation.
Implications:
- Modified central bisegmentectomy is a volume-saving surgical option for centrally located pediatric hepatoblastoma.
- This approach can significantly reduce morbidity and mortality associated with liver tumor resection.
- It offers a potentially superior alternative to traditional trisegmentectomy for preserving liver function.