Comparison of Safety and Outcomes Between Laparoscopic and Open Resection of Small Hepatoblastoma Tumors in Children

Hepatoblastoma, a rare malignant tumor, predominantly affects children under 2 years of age. Surgical resection remains the primary treatment, but the benefits of laparoscopic surgery (LAP) compared with open surgery (OPEN) are debated. This retrospective study analyzed 76 pediatric hepatoblastoma patients with tumors ≤5 cm treated between February 2020 and February 2022, most of whom received neoadjuvant chemotherapy to facilitate tumor shrinkage and resectability. Patients who underwent LAP (n=37) or OPEN (n=39) were compared based on surgical outcomes, liver function, postoperative complications, and oncologic outcomes, including event-free survival (EFS) and overall survival (OS). Laparoscopic surgery was performed only in carefully selected patients with peripheral tumors without major vascular involvement. The LAP group had a longer operative time (237.4±26.7 vs. 183.7±23.9 min, P<0.001) but less estimated blood loss (75.7±9.8 vs. 108.1±14.0 mL, P<0.001), shorter time to regular diet (1.35±0.18 vs. 2.55±0.26 d, P<0.001), lower postoperative opioid requirement (36.2±5.1 vs. 52.8±7.3 MME, P<0.001), and shorter hospital stays (6.8±0.9 vs. 11.4±1.1 d, P<0.001). Postoperative liver function indicators, including alanine aminotransferase, aspartate aminotransferase, and total bilirubin, were lower in the LAP group (P<0.001). After a median follow-up of 29 months, there was no significant difference in event-free survival (82.2% vs. 75.1%), overall survival (93.7% vs. 90.1%), recurrence, or complication rates between groups (P>0.05). LAP appears safe and effective for selected hepatoblastoma with tumors ≤5 cm, offering quicker recovery and less invasiveness. Open surgery remains essential for central or larger tumors not amenable to safe laparoscopic resection. However, selection bias favoring LAP for smaller and peripheral tumors may limit generalizability. Prospective studies are needed to confirm these results.