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Hepatic resections for pediatric hepatoblastoma: analysis of 30-day outcomes using the National Surgical Quality
Humza Thobani1,2, Rafia Durrani1, Steven L Raymond3
1Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan.
Insights
Surgical resection for hepatoblastoma in children has excellent outcomes. Extended resections, including trisectionectomy, do not show worse 30-day results despite increased complexity and transfusion needs.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Surgical resection is the primary treatment for pediatric hepatoblastoma.
- Optimizing surgical strategies is crucial for improving disease-free survival.
- Analyzing outcomes based on resection extent is vital for patient management.
Purpose of the Study:
- To evaluate 30-day outcomes of pediatric hepatoblastoma resection.
- To stratify outcomes by the extent of hepatic resection.
- To identify predictors of adverse events using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database.
Main Methods:
- Retrospective analysis of NSQIP-P data (2012-2021).
- Inclusion of pediatric patients undergoing hepatoblastoma resection.
- Multivariate logistic regression to identify predictors of adverse outcomes.
Main Results:
- 458 children included; median age 1.90 years.
- Overall complications were infrequent; common events included blood transfusion (64.2%) and prolonged ventilation (10.0%).
- Trisectionectomy was associated with higher odds of significant blood transfusion; extended resections showed higher rates of transfusion and prolonged ventilation but similar overall 30-day outcomes.
Conclusions:
- Hepatic resection for hepatoblastoma in children yields excellent 30-day outcomes.
- Extended resections, while more complex, do not lead to worse short-term adverse events.
- Trisectionectomy may require increased blood transfusion volumes, necessitating careful perioperative management.
Background:
Surgical resection remains the cornerstone of treatment for hepatoblastoma in children and offers the best chance of disease-free survival. We aimed to analyze the 30 day outcomes of hepatic resection for hepatoblastoma stratified by extent using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P).
Methods:
We queried NSQIP-P for children undergoing resection of Hepatoblastoma from 2012 to 2021. Relevant clinical characteristics and outcomes were extracted for multivariate logistic regression to identify predictors of common adverse outcomes.
Results:
We included 458 children with a median age of 1.90 years. Overall complications were rare, and perioperative blood transfusion (64.2%) and postoperative ventilation > 48 h (10.0%) were the only adverse events prevalent in more than 5% of patients. Median transfusion volume was 15.7 ml/kg. On multivariate regression, only patients undergoing Trisectionectomy (aOR = 3.387, 95% C.I. = 1.348-8.510) had higher odds of receiving > 75th percentile blood transfusion. Furthermore, only perioperative transfusion and postoperative ventilation > 48 h were statistically more common in patients undergoing extended versus standard resections.
Conclusions:
Outcomes following resection of hepatoblastoma are excellent, with low rates of postoperative adverse events. Although children undergoing trisectionectomy likely require greater transfusion volume, extended hepatic resections do not appear to have worse 30 day outcomes despite greater operative complexity and duration.
