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[Hepatic resection technique in children]
1Klinika dĕtské chirurgie FN Motol a 2. LF UK, Praha.
Insights
Surgical advancements significantly improved outcomes for pediatric liver resections. Outcomes improved from 33% to 86.5% survival after changes in surgical tactics and anesthesia in 1990.
Area of Science:
- Pediatric surgery
- Hepatobiliary surgery
- Surgical oncology
Context:
- Liver resections in children present unique surgical challenges.
- A significant change in surgical tactics, technique, and anesthesia occurred in 1990.
- This study compares outcomes before and after this pivotal change.
Purpose:
- To evaluate the impact of modified surgical techniques and anesthesia on pediatric liver resection outcomes.
- To compare mortality and survival rates between two distinct surgical periods.
- To assess the effectiveness of current liver resection methods in managing pediatric liver tumors.
Summary:
- 34 major liver resections were performed between 1986-1993 in children.
- The study divided patients into two groups based on surgical period (1986-1989 vs. 1990-1993).
- Outcomes including operative mortality, early/late deaths, and survival rates were analyzed, showing significant improvement in the second period.
Impact:
- Operative mortality decreased from 25% to 0%.
- Early mortality decreased from 25% to 4.5%.
- Patient survival increased from 33% to 86.5%, with a notable improvement in survival for malignant tumors (15% to 83% without relapse).
Abstract:
The authors present their experience with resection of the liver in children. In 1986-1993 they performed a total of 34 major resections of the liver. The mean age of the operated children was 4 years and 5 months, the youngest patient was operated at the age of 4 days and the oldest one at the age of 17 years. The group was divided into two time periods which are compared, because in 1990 the authors changed their surgical tactics and technique and also the procedure used for general anaesthesia. During the first period/1986-1989/they made 12 resections of the liver and during the second period/1990-1993/22 resections. The two groups of patients are compared as regards mortality during operation, early and late deaths. In the first period the mortality was 25%, in the second period no death occurred during operation. Early deaths were recorded during the first period in 25%, during the second period in 4.5%. Patient survival during the first period is 33% and during the second period 86.5%. The authors describe the technique of resection of the liver they use at present with emphasis on isolation of the vena cava inferior with the possibility of easier control of haemorrhage and the use of an ultrasonic aspirator/CUSA/and laser during resection proper which makes easier identification of hepatic structures and control of blood losses on operation possible. In malignant tumours the radicality of surgery increased as manifested on patient survival. From the first period 15% patients survive, from the second period 83% without signs of relapse.