Surgical strategies for unresectable hepatoblastomas.

Area of Science:

• Pediatric Oncology
• Surgical Gastroenterology
• Hepatobiliary Surgery

Background:

• Unresectable hepatoblastomas present significant surgical challenges at initial diagnosis.
• Assessing surgical strategies is crucial for improving outcomes in pediatric liver cancer.

Purpose of the Study:

• To evaluate surgical approaches for unresectable hepatoblastomas based on initial diagnosis.
• To analyze the effectiveness of the PRETEXT and POST-TEXT staging systems in guiding treatment decisions.

Main Methods:

• Retrospective analysis of 12 unresectable hepatoblastoma cases (PRETEXT III/IV, M-) treated under the JPLT-2 protocol.
• Evaluation of PRETEXT and POST-TEXT staging, surgical interventions, and clinical outcomes.
• Assessment of downstaging after chemotherapy cycles (CITA).

Main Results:

• Downstaging observed in cases with PRETEXT III and IV after chemotherapy.
• Four of seven cases with P2 or V3 factors showed similar POST-TEXT staging, with one undergoing primary liver transplantation.
• Trisegmentectomy was a common initial surgical treatment, with noted complications like bile leakage and hepatic vein obstruction. Rescue liver transplantation was performed in two cases.

Conclusions:

• POST-TEXT staging and P/V factors are critical after 2 cycles of CITA for unresectable hepatoblastomas.
• Referral for liver transplantation is indicated for POST-TEXT IV, P2, or V3 cases.
• Trisegmentectomy is recommended for liver resection due to lower complication rates; backup transplantation is advised for advanced cases.