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Surgical Resection for Hepatoblastoma-Updated Survival Outcomes
Bhanu Jayanand Sunil1,2, Ravisankar Palaniappan3, Balasubramanian Venkitaraman3
1Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, India. drsunilbjs@yahoo.co.in.
Insights
Pediatric hepatoblastoma patients undergoing liver resection after neoadjuvant therapy show excellent survival outcomes. This multidisciplinary approach ensures good disease control and long-term survival for young liver cancer patients.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Hepatoblastoma is the most common primary liver cancer in children.
- Management requires a multidisciplinary approach involving chemotherapy, radiation, and surgery.
Purpose of the Study:
- To analyze the outcomes of pediatric hepatoblastoma patients who underwent liver resection.
- To evaluate the safety and efficacy of neoadjuvant treatment followed by surgery.
Main Methods:
- Retrospective analysis of 12 pediatric hepatoblastoma patients undergoing liver resection (2000-2013).
- Patients received neoadjuvant chemotherapy (PLADO) and/or radiation prior to surgery.
- Survival outcomes and disease control were assessed.
Main Results:
- The 5-year overall survival rate was 91% with a median survival of 120 months.
- Most patients (8/12) had advanced stage III disease (PRETEXT staging).
- Microscopic positive margins occurred in 3 cases, with one lung recurrence.
Conclusions:
- Liver resection is a safe and effective treatment for pediatric hepatoblastoma following neoadjuvant therapy.
- Neoadjuvant treatment followed by surgical resection leads to good disease control and long-term survival.
Background:
Hepatoblastoma is the most common liver malignancy in the pediatric age group. The management of hepatoblastoma involves multidisciplinary approach.
Methods:
Patients with hepatoblastoma who underwent liver resection between 2000 and 2013 were analyzed and survival outcomes were studied.
Results:
The crude incidence rate of hepatoblastoma at the Madras Metropolitan Tumor Registry (MMTR) is 0.4/1,00,000 population per year. Twelve patients underwent liver resection for hepatoblastoma during the study period; this included eight males and four females. The median age at presentation was 1.75 years (Range 5 months to 3 years). The median serum AFP in the study population was 20,000 ng/ml (Range 4.5 to 1,40,000 ng/ml). Three patients had stage I, one patient had stage II, and eight patients had stage III disease as per the PRETEXT staging system. Two patients were categorized as high risk and ten patients were categorized as standard risk. Seven of these patients received two to four cycles of neoadjuvant chemotherapy (PLADO regimen), and one patient received neoadjuvant radiation up to 84 Gy. Major liver resection was performed in nine patients. Nine patients received adjuvant chemotherapy. The most common histological subtype was embryonal type. Microscopic margin was positive in three cases. One patient recurred 7 months after surgery and the site of failure was the lung. The 5-year overall survival of the case series was 91%. The median survival was 120 months.
Conclusion:
Liver resections can be safely performed in pediatric populations after neoadjuvant treatment. Patients undergoing surgery had good disease control and long-term survival.
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