Successful nontransplant resection of POST‐TEXT III and IV hepatoblastoma

Abstract

Excellent survival (93%) was obtained with aggressive resection in children with POST-TEXT III and IV hepatoblastoma meeting criteria for transplant referral. The 1 death occurred in a patient with unfavorable small cell histology. These children should be managed at institutions experienced in both advanced pediatric hepatobiliary surgery and transplantation. Operative exploration was frequently required to ultimately determine which tumors can be resected and which require transplantation.

Surgical treatment of childhood hepatoblastoma in the Netherlands (1990–2013)

“…Nonetheless, inadequate quantity or quality of residual liver mass remains a potential cause of liver failure and may require additional transplantation. Therefore, central review and surgical management at institutions experienced in both advanced pediatric hepatobiliary surgery and transplantation is essential for these children [28,29]. In this study, two patients needed rescue transplantation after partial liver resection because of liver failure.…”

“…In children, resection of 80 % of the liver mass can be accepted after treatment with toxic agents [26]. To avoid long-term side effects of immunosuppressive therapy after transplantation, surgeons might extend criteria in favor of resection rather than transplantation in patients with extensive disease [28,29]. Nonetheless, inadequate quantity or quality of residual liver mass remains a potential cause of liver failure and may require additional transplantation.…”

Usefulness of three-dimensional(3D) simulation software in hepatectomy for pediatric hepatoblastoma

“…Furthermore, the introduction of neoadjuvant chemotherapy regimens allows many initially unresectable tumors to be safely removed [1]. To completely resect HB, the surgical team must grasp the tumor extent which is determined from computed tomography (CT) imaging using PRETEXT (the PRETreatment EXTent of disease system) or POST-TEXT (the studies obtained after treatment with neoadjuvant chemotherapy) in the Children's Oncology Group (COG) HB protocol (AHEP0731) [5]. Nevertheless, intraoperative use of conventional CT imaging is based on cognitive analysis by the surgeon to transpose on 2D images into 3D, afterwards integrate preoperative data into the operative field.…”

Liver tumours in children: Current surgical management and role of Transplantation

“…3). [13][14][15] Another extreme surgical concept is extending the hepatic resection with transplantation as an immediate back-up or saftey net should a complete resection, having been embarked on, turn out not to be possible. We did this in a 10-year-old boy with a large central fibrolamellar tumour, performing an extended left hepatectomy with Roux-en-Y drainage of an obstructed right segment 6,7 bile duct with long-term success; the patient was healthy 17 years post resection.…”

“…The resections available are tumourectomy (non-anatomical), segmentectomy, (segments 4a,b) central resection, hemihepatectomy (right or left liver, along Cantlie's line), extended hepatectomy (right or left), staged resection after portal vein occlusion, ex vivo surgery with autotransplantation and transplantation, which may be primary or as rescue after local recurrence following a previous attempt at curative resection. [2,10,15] Strategies for safe liver resection include protecting the liver during the resection with ischaemic preconditioning, avoiding any venous outflow obstruction from kinking or narrowing of the residual hepatic vein and reduction of postresection hyperperfusion, which may lead to congestion. This is done using a variety of techniques to reduce inflow of blood to the much smaller residual liver, which include splenic artery ligation, partial portosystemic shunting and the use of β-blockers such as propranolol.…”