Early Surgical Outcome of Hepatoblastoma in Children Receiving Chemotherapy After Hepatic Resection

The aim of this study was to evaluate surgical outcomes in children with hepatoblastoma who underwent hepatic resection after receiving neoadjuvant chemotherapy.

A prospective observational longitudinal study was conducted from February 2019 to July 2020 in the Department of Pediatric Surgery at Bangabandhu Sheikh Mujib Medical University, Bangladesh. A total of 13 children diagnosed with hepatoblastoma and classified as PRETEXT (Pre-Treatment Extent of Disease) stages I to III were included. Detailed medical histories were recorded, and diagnoses were confirmed through histopathological analysis. Preoperative evaluations included liver function tests (LFTs), serum alpha-fetoprotein (AFP) levels, and imaging for tumor staging and liver volume. Postoperative assessments were conducted at one, three, and six months to monitor changes in serum AFP levels, LFTs, liver volume, and hepatic echotexture. The type of hepatic resection performed and any complications encountered were also documented.

Among the 13 patients, the majority were male, with a male-to-female ratio of 12:1. The average age at diagnosis was 4.44 years, with most patients under three years old. Pathological analysis revealed epithelial tumors in 38.45% of cases, fetal-type tumors in 46.15%, and mixed tumors in 15.4%. PRETEXT stage III was the most common (53.85%), and 61.54% of patients underwent major hepatic resections. Postoperative serum AFP levels showed a significant decline, reflecting successful tumor resection and improvements in LFTs. Improvements in LFTs, including key enzymes like ALT and AST, were observed. A marked increase in hepatic regeneration was observed within six months, with no local recurrences recorded.

This study highlights the effectiveness of combining hepatic resection with neoadjuvant chemotherapy in treating pediatric hepatoblastoma. A significant decline in serum AFP levels after surgery reflects the success of tumor removal, while improvements in LFTs underscore the recovery of hepatic health. Furthermore, the observed increase in hepatic regeneration within six months demonstrates the liver's remarkable ability to recover and sustain long-term function. These findings emphasize the importance of early diagnosis, precise surgical techniques, and individualized treatment planning in improving outcomes for pediatric hepatoblastoma.