Pediatric hepatic surgery

Tumors of the liver are uncommon in children. It is imperative that surgeons caring for these patients have a knowledge of the likely diagnosis, proper radiographic evaluation, and appropriate selection and extent of surgical therapy. Of the benign lesions, infantile hemangioendothelioma often is best treated nonoperatively, whereas mesenchymal hamartoma and teratoma should be resected. All malignant lesions must be completely excised to cure the patient, but some may be converted from unresectable tumors to resectable ones by preoperative chemotherapy. Major hepatic resection is one of the most formidable procedures in the surgery of children. Careful preparation, attention to technical detail, and precise postoperative management of the critically ill child are prerequisites for success. For a recent review of the extrahepatic biliary tract problems of infants and children, the reader is referred to the article by Stolar and Altman in Surgical Clinics of North America, Volume 65, October 1985.