Subscribe to RSS
Feasibility of Nonanatomical Liver Resection in Diligently Selected Patients with Hepatoblastoma and Comparison of Outcomes with Anatomic Resection
Introduction Treatment guidelines for hepatoblastoma discourage nonanatomic liver resections. However, the evidence for this is inadequate and comes from a study performed almost two decades ago which additionally contained inherent limitations. This study aimed to assess the feasibility and oncologic outcomes of nonanatomic resections (NAR) performed in diligently selected patients and compare the results with anatomic resections (AR).
Materials and Methods A total of 120 patients who underwent liver resections for hepatoblastoma between January 2008 and July 2019 were reviewed. Feasibility of NAR was based on postchemotherapy relations to vessels, site of the lesion, and possibility of achieving negative resection margins.
Results AR was performed in 95 patients and 25 had NAR. The NAR cohort had similar International Childhood Liver Tumors Strategy Group (SIOPEL) risk group distribution. Blood loss and operative times were lower in patients undergoing NAR. No differences were noted between the two groups concerning postoperative morbidity and hospitalization. There were no pathologic positive margins or local recurrences in the NAR patients. Relapse free (RFS) and overall survival (OS) was similar in the two groups (p = 0.54 and 0.96, respectively). Subgroup analysis of only posttreatment extent of tumor (POSTTEXT) I and II patients also showed no difference in RFS or OS for the two groups with a persistent significant difference in operative times and blood loss.
Conclusion NAR is feasible with clear margins in carefully selected patients. It is not associated with more complications and outcomes are not inferior to AR. NAR is associated with lesser blood loss and operative time.
Received: 05 February 2020
Accepted: 05 April 2020
18 May 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Fuchs J, Rydzynski J, Hecker H. , et al; German Cooperative Liver Tumour Studies HB 89 and HB 94. The influence of preoperative chemotherapy and surgical technique in the treatment of hepatoblastoma--a report from the German Cooperative Liver Tumour Studies HB 89 and HB 94. Eur J Pediatr Surg 2002; 12 (04) 255-261
- 2 Fuchs J, Rydzynski J, Von Schweinitz D. , et al; Study Committee of the Cooperative Pediatric Liver Tumor Study Hb 94 for the German Society for Pediatric Oncology and Hematology. Pretreatment prognostic factors and treatment results in children with hepatoblastoma: a report from the German Cooperative Pediatric Liver Tumor Study HB 94. Cancer 2002; 95 (01) 172-182
- 3 Meyers RL, Tiao G, de Ville de Goyet J, Superina R, Aronson DC. Hepatoblastoma state of the art: pre-treatment extent of disease, surgical resection guidelines and the role of liver transplantation. Curr Opin Pediatr 2014; 26 (01) 29-36
- 4 Czauderna P, Otte JB, Aronson DC. , et al; Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL). Guidelines for surgical treatment of hepatoblastoma in the modern era--recommendations from the Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL). Eur J Cancer 2005; 41 (07) 1031-1036
- 5 Towbin AJ, Meyers RL, Woodley H. et al. 2017 PRETEXT: radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT). Pediatr Radiol 2018; 48 (04) 536-554
- 6 Pritchard J, Brown J, Shafford E. et al. Cisplatin, doxorubicin, and delayed surgery for childhood hepatoblastoma: a successful approach--results of the first prospective study of the International Society of Pediatric Oncology. J Clin Oncol 2000; 18 (22) 3819-3828
- 7 Aronson DC, Weeda VB, Maibach R. , et al; Childhood Liver Tumour Strategy Group (SIOPEL). Microscopically positive resection margin after hepatoblastoma resection: what is the impact on prognosis? A childhood liver tumours strategy group (SIOPEL) report. Eur J Cancer 2019; 106: 126-132
- 8 Buettner S, Gani F, Amini N. et al. The relative effect of hospital and surgeon volume on failure to rescue among patients undergoing liver resection for cancer. Surgery 2016; 159 (04) 1004-1012
- 9 Jarnagin WR, Gonen M, Fong Y. et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002; 236 (04) 397-406
- 10 Lautz TB, Ben-Ami T, Tantemsapya N, Gosiengfiao Y, Superina RA. Successful nontransplant resection of POST-TEXT III and IV hepatoblastoma. Cancer 2011; 117 (09) 1976-1983