Is Laparotomy the First Step in Treatment of Childhood LiverTumors? - The Experience from the German Cooperative Pediatric Liver Tumor Study HB-89

Where do we stand with hepatoblastoma?

“…A diagnostic biopsy often is omitted if the intention is to treat a tumor that is confined to a single liver lobe with surgery only 55, 56. Nevertheless, a biopsy often is recommended to all patients for accurate diagnosis.…”

“…Accordingly, it was found that pretreatment with a combination of cisplatin and doxorubicin (the SIOPEL strategy) improved the prognosis of children with HB, and that strategy has remained the main SIOPEL treatment principle. Some study groups opted for primary resection if possible and only began chemotherapy and second‐look surgery if primary surgery was not possible 55, 83. In contrast, the prospective SIOPEL‐1 trial was the first study that had the intention of treating all patients with preoperative neoadjuvant chemotherapy.…”

Pediatric liver tumors: Initial presentation, image finding and outcome

“…Liver tumors account for only 0.5 to 2.0% of all pediatric tumors, therefore, reports of liver tumors in infants and children are relatively rare and deal mainly with histological findings and surgical procedures 1–7 . Generalizations about initial presentations, laboratory data, image studies and outcomes of pediatric liver tumors are difficult to make because of the rarity of these tumors although they have been investigated from various points of view in adults 8–10 .…”

Transplantation for liver and biliary cancer

“…Surgical resection is the treatment of choice, but at the time of presentation the massive size and central location of many of the tumors makes them inoperable. It has been shown, however, that preoperative imaging was inaccurate in some 20% of cases [44] and overestimation of tumor involvement by CT has erroneously predicted unresectable tumors [45]. Of course, a tumor evaluated as unresectable by an inexperienced surgeon may be considered resectable by an experienced surgeon [46].…”