Primary liver transplantation is recommended for central POSTTEXT III and POSTTEXT IV hepatoblastoma. Aim is to prospectively assess safety, oncological efficacy of aggressive non-transplant extended hepatic resections in those patients. Methods: Study included 18 children with central PRE-TEXT III and IV, 3 had primary liver transplantation whereas 15 underwent hepatic resection after neoadjuvant chemotherapy. Results: Median tumor volume was 317 ml (range 135-546). After 4 cycles chemotherapy, POST-TEXT was III in 12 and IV in 3 patients. There was no perioperative mortality. Postoperative complications were 2 bile leaks, one temporary decompensation and one sub-phrenic collection requiring drainage. 1 and 3 years disease free survival was 93.3% and 73.3% respectively. 3 years overall survival was 86.6%. Four patients developed recurrence, of which two died. Early recurrence within one year occurred in one patient. All recurrences were distant metastases. Conclusions: Extended major hepatic resection for selected cases of POST-TEXT III and IV hepatoblastoma is technically challenging but feasible approach with acceptable morbidity and mortality rates. Oncological outcomes are comparable to liver transplantation without the longterm commitment of immunosuppression or donor risk and morbidity however; potential donor should always be prepared for plan B if needed.
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