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Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy
Published on: March 10, 2023
Hepatoblastoma: a single institutional experience of 18 cases
Parul J Shukla1, Savio G Barreto, Sajid S Qureshi
1Department of Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai 400 012, India. pjshukla@doctors.org.uk
Insights
Multidisciplinary management of hepatoblastoma, a rare childhood liver tumor, involving surgery and chemotherapy, achieved complete resection in all patients with low mortality and morbidity. This approach offers a promising survival rate for pediatric liver cancer.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Hepatoblastoma is the most common pediatric liver tumor, though rare overall.
- Global data integration is needed for multidisciplinary management outcomes.
- This study reviews single-institution experience with hepatoblastoma resection.
Purpose of the Study:
- To retrospectively analyze outcomes of surgically resected hepatoblastomas.
- To evaluate the efficacy of multidisciplinary management including chemotherapy and surgery.
- To assess survival rates and complications in pediatric hepatoblastoma patients.
Main Methods:
- Retrospective analysis of 18 pediatric patients with hepatoblastoma.
- Patients managed surgically with preoperative chemotherapy between 2000-2007.
- Evaluation of primary outcomes (survival, morbidity) and secondary outcomes (resection completeness).
Main Results:
- Complete gross resection (Stages I & II) achieved in 100% of patients.
- Mortality rate was 0%, with morbidity at 11.2%.
- 80-month disease-free survival was 67%; chemotherapy aided tumor downstaging.
Conclusions:
- Major liver resection for hepatoblastoma is feasible with minimal complications.
- Multidisciplinary care, including chemotherapy and surgery, improves outcomes.
- This study represents a significant contribution to Indian data on hepatoblastoma surgical management.
Abstract:
Hepatoblastomas are the most common liver tumours in children. However, they are rare as compared to other solid malignancies. Thus, there is a need to integrate data from surgical centers around the world to provide a clearer view on the outcomes of multidisciplinary management of these tumours. We set out to retrospectively review our experience of patients with surgically resected hepatoblastomas looking at primary and secondary outcomes. Children diagnosed with hepatoblastoma and managed surgically (along with chemotherapy) at a single institution between 1 January 2000 and 31 May 2007, were analyzed. Out of the 18 patients, there were 12 male and 6 female patients. The median age was 18 months (range 8-72). A palpable mass in abdomen was the presenting symptom in 88% patients. Sixteen patients (88.8%) underwent major liver resection. Sixteen patients (88.8%) received preoperative chemotherapy. Complete gross resection (stage I and II) was achieved in all 18 patients (100%). The mortality and morbidity rates were 0 and 11.2%, respectively. The 80-month disease-free survival was 67%. This series, the largest from India in terms of surgical resections for hepatoblastoma, reaffirms that major liver resection can be performed with minimal perioperative mortality and morbidity and that the use of chemotherapy has definitely helped in down staging tumours for liver resection.
