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A Preclinical Murine Model of Hepatic Metastases
Published on: September 27, 2014
Hepatic Metastasectomy in Pediatric Patients: An Observational Study
Andrew M Fleming1, Sara A Mansfield1, Tim Jancelewicz1
1St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA.
Insights
Hepatic metastasectomy is safe and effective in children with metastatic disease, potentially guiding treatment and improving long-term survival. This study highlights its utility in selected pediatric cases.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Hepatic Surgery
Background:
- The role of hepatectomy for pediatric metastatic disease is debated.
- Potential benefits include cure, diagnosis, and chemotherapy guidance.
- This study assesses hepatic metastasectomy's safety and utility in children.
Purpose of the Study:
- To evaluate the safety and utility of hepatic metastasectomy in pediatric patients.
- To determine the impact of metastasectomy on adjuvant therapy decisions.
- To analyze survival outcomes following hepatic metastasectomy in children.
Main Methods:
- Retrospective review of medical records (1995-2022) for children undergoing hepatic metastasectomy.
- Exclusion of en-bloc hepatectomies during primary tumor resection.
- Data collected on patient demographics, tumor characteristics, surgical procedures, and outcomes.
Main Results:
- 16 pediatric patients underwent hepatic metastasectomy for various histologies.
- No Clavien-Dindo Class III or higher perioperative morbidity observed.
- 10-year disease-specific survival was 77%, and disease-free survival was 61%.
Conclusions:
- Hepatic metastasectomy is a safe procedure in pediatric patients.
- Metastasectomy can inform adjuvant therapy decisions.
- The procedure is associated with favorable long-term survival in selected children.
Background:
The role of hepatectomy for metastatic disease in children is controversial. Rationales include potential cure, obtaining a diagnosis, and guiding chemotherapy decisions. This study examines the safety and utility of hepatic metastasectomy for children at a single institution.
Methods:
After IRB approval (#22-1258), medical records were reviewed from 1995 to 2022 for children undergoing hepatic metastasectomy. En-bloc hepatectomies during primary tumor resection were excluded.
Results:
Hepatic metastasectomy was performed in 16 patients for a variety of histologies. Median patient age was 12.2 years [IQR 6.9-22.6], and 13/16 patients were female (81 %). Number of hepatic metastases ranged from 1 to 23 and involved between 1 and 8 Couinaud segments. Anatomic resections included 4 hemihepatectomies and 1 sectionectomy. All other resections were nonanatomic. 3/6 resections for germ cell tumor (GCT) revealed only mature teratoma, driving adjuvant therapy decisions. When indicated, median time to adjuvant chemotherapy was 19 days [IQR 11-22]. No patients had Clavien-Dindo Class III or higher perioperative morbidity. Three patients (1 GCT, 1 adrenocortical carcinoma (ACC), and 1 gastric neuroendocrine tumor (GNET) experienced hepatic relapse. The patients with relapsed GCT and GNET are alive with disease at 17 and 135 months, respectively. The patient with ACC died of disease progression and liver failure. One patient with Wilms tumor experienced extrahepatic, retroperitoneal recurrence and died. With a median follow-up of 38 months, 10-year disease-specific and disease-free survival were 77 % and 61 %, respectively.
Conclusions:
Hepatic metastasectomy can be accomplished safely in children, may guide adjuvant therapy decisions, and is associated with long-term survival in selected patients.
Level Of Evidence:
Level IV.
Type Of Study:
Treatment Study, Case series with no comparison group.
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