Open Questions in Surgery for Hepatoblastoma: A Joined SIOPEL-IPSO Survey

Area of Science:

• Pediatric Surgery
• Surgical Oncology
• Hepatobiliary Surgery

Background:

• Hepatoblastoma (HB) management relies heavily on surgical intervention, but techniques and approaches differ significantly among surgeons.
• The International Society of Pediatric Oncology Liver Group (SIOPEL) and International Pediatric Surgical Oncology (IPSO) collaborated to address this variability.

Purpose of the Study:

• To investigate specific technical aspects and challenging indications in hepatoblastoma surgery through a global online survey.
• To identify areas of consensus and divergence in surgical decision-making for hepatoblastoma.
• To lay the groundwork for developing standardized, evidence-based guidelines for HB surgical management.

Main Methods:

• An online survey with 50 multiple-choice items was developed and distributed to SIOPEL and IPSO members.
• The survey focused on preoperative assessment and specific surgical challenges in hepatoblastoma management.
• Responses were collected from 52 surgeons across 25 countries, including transplant (LT) and non-LT surgeons.

Main Results:

• Significant heterogeneity in surgical preferences was observed, particularly regarding masses near suprahepatic veins and satellite nodules.
• Transplant surgeons favored liver transplantation (LT) for suprahepatic vein masses, while non-LT surgeons preferred resection.
• Surgeons' choices for hilar plate masses and inferior vena cava (IVC) infiltration management also showed significant differences based on LT experience.

Conclusions:

• The study reveals a lack of standardized surgical approaches for hepatoblastoma, highlighting diverse surgeon practices.
• Further analysis is needed to correlate management strategies with patient outcomes.
• The findings emphasize the necessity for developing evidence-based guidelines to optimize surgical care for hepatoblastoma.