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Outcome of Liver Resection for Hepatoblastoma in Children from a General Pediatric Surgery Referral Center
Sukrit Singh Shah1, Vikram Khanna1, Subhasis Roy Choudhury1
1Department of Pediatric Surgery, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.
Insights
Pediatric liver resection for hepatoblastoma (HB) combined with neoadjuvant chemotherapy yields excellent survival rates. Meticulous surgical techniques and anatomical understanding are key to successful outcomes in treating this common childhood liver cancer.
Area of Science:
- Pediatric Surgery
- Pediatric Oncology
- Hepatobiliary Surgery
Background:
- Hepatoblastoma (HB) is the most common pediatric liver malignancy.
- Surgical resection and neoadjuvant chemotherapy are standard treatments for HB.
- This study details a 10-year experience with liver resection in pediatric HB patients.
Purpose of the Study:
- To review institutional experience with liver resection for hepatoblastoma.
- To highlight technical considerations for optimizing surgical outcomes.
- To analyze recurrence and survival rates following resection.
Main Methods:
- Retrospective review of pediatric HB patients undergoing liver resection (2014-2024).
- All patients received neoadjuvant PLADO chemotherapy (cisplatin + doxorubicin) per SIOPEL guidelines.
- Surgical resection types, outcomes, recurrence, and survival data were analyzed.
Main Results:
- 19 of 26 HB patients (73%) underwent liver resection.
- Right hepatectomy was most common; all had negative surgical margins.
- Disease-free survival was 89.5%, overall survival at 5 years was 81.8% with no postoperative liver failure.
Conclusions:
- Liver resection combined with PLADO/SIOPEL chemotherapy offers favorable outcomes for pediatric HB.
- Meticulous surgical technique and anatomical knowledge are crucial for minimizing complications and improving results.
Background:
Hepatoblastoma (HB) is the most common malignant liver tumor in children under 3 years of age. Surgical resection, combined with neoadjuvant chemotherapy, is essential for optimal outcomes. We present a 10-year institutional experience focusing on technical tips for liver resection in children with HB.
Materials And Methods:
A retrospective review of pediatric HB patients who underwent liver resection at a tertiary care Children's hospital from January 2014 to June 2024 was conducted. All patients received preoperative PLADO (cisplatin + doxorubicin) chemotherapy per SIOPEL guidelines. Surgical resection type, outcomes, recurrence, and survival data were analyzed. Technical considerations for standard and complex hepatectomies were described.
Results:
Out of 26 children with HB (mean age 15 months), 19 (73%) underwent liver resection. Right hepatectomy was the most common (42%), followed by left hepatectomy and segmentectomies. No patient developed postoperative liver failure. Two patients (10.5%) experienced recurrence; one was salvaged successfully. The disease-free survival rate was 89.5%, and overall survival at 3 and 5 years was 81.8%. Surgical margins were negative in all patients. Technical tips adopted to improve visualization, minimize blood loss, avoid bile duct injury, and vascular inflow and outflow control are detailed.
Conclusion:
Liver resection with adjuvant chemotherapy (PLADO and SIOPEL) results in favorable outcome in children with HB. Understanding the anatomical nuances and meticulous surgical technique improves outcomes and minimizes complications.
