Surgical management in hepatoblastoma: points to take

Murawski, Maciej; Weeda, Víola B.; Czauderna, Piotr

doi:10.1007/s00383-022-05356-z

Cited by 11 publications

(12 citation statements)

References 62 publications

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“…The primary benefits of the ALPPS procedure stem from the rapid hypertrophy of the future liver remnant (FLR), which surpasses that of other FLR-enhancing techniques like Portal Vein Embolization (PVE) ( 17 ). This accelerated growth increases the chances of achieving complete tumor resections (R0) while potentially reducing the risk of postoperative liver failure, positioning it as a surgical option to consider ( 17 ). Additionally, the shortened time span between the two stages of surgery offered by ALPPS minimizes the risk of tumor progression compared to other hypertrophy-inducing methods ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: ALPPS hepatectomy, an alternative to liver transplantation in central PRETEXT III hepatoblastomas: a case series

Garcia Moreno,

Alzate-Ricaurte,

Alzate Gallego

et al. 2024

Front. Pediatr.

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IntroductionHepatoblastoma is the most common malignant primary liver tumor in the pediatric population, accounting for 67% of cases in the United States. Surgical resection is the only curative treatment option; however, it can be performed in only 10% of patients with primary tumors. The two most common limitations for resection are the need for extensive resections and tumors in central locations. The therapeutic hypertrophy of healthy tissue achieved with ALPPS (Associating Liver Partition and Portal vein ligation for Staged Hepatectomy) enables larger resections and has been successfully employed in the pediatric population in recent years.ObjectiveTo present three cases of patients with centrally located PRETEXT II or III hepatoblastomas who underwent ALPPS procedure as a viable therapeutic alternative to liver transplantation.Discussion and resultsCentral PRETEXT III hepatoblastomas are typically indications for liver transplantation. Transplantation offers high five-year survival rates (73%). However, the associated morbidity, healthcare system costs, and limited availability make it necessary to explore alternative options. Series have reported the successful application of the ALPPS procedure in PRETEXT II and PRETEXT III hepatoblastomas in other locations. Therapeutically induced hypertrophy, characterized by an increase in the volume of healthy tissue in unaffected lobes or segments, enabled the resection of previously deemed unresectable lesions. The patients experienced uncomplicated postoperative courses and expected reduction in tumor markers. Chemotherapy selection followed the guidelines outlined in Block C of the SIOPEL IV protocol.ConclusionsALPPS hepatectomy is a viable therapeutic option for patients with centrally located PRETEXT III or II hepatoblastomas.

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Section: Discussionmentioning

confidence: 99%

Case Report: ALPPS hepatectomy, an alternative to liver transplantation in central PRETEXT III hepatoblastomas: a case series

Garcia Moreno,

Alzate-Ricaurte,

Alzate Gallego

et al. 2024

Front. Pediatr.

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“…“P” refers to the MPV, the BPV, or both. The proximity classification was based on the tumor's distance to these vessels: (1) Within 1 cm (V0 or P0); (2) touching (V1 or P1); (3) compressing, or encasing (V2 or P2); and (4) presence of a tumor thrombus or cavernous transformation of the MPV (V3 or P3)[ 2 , 3 ].…”

Section: Methodsmentioning

confidence: 99%

“…Hepatoblastoma (HB) is the most common primary malignant liver tumor in children, and its incidence is increasing[ 1 , 2 ]. The combination of surgery and chemotherapy, particularly neoadjuvant chemotherapy (NAC), has allowed for the delayed resection of many children initially considered unresectable at diagnosis, resulting in a significant improvement in the survival rate of HB patients from approximately 30%[ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Computer-assisted three-dimensional individualized extreme liver resection for hepatoblastoma in proximity to the major liver vasculature

Xiu,

Liu,

Zhang

et al. 2024

World J Gastrointest Surg

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BACKGROUND The management of hepatoblastoma (HB) becomes challenging when the tumor remains in close proximity to the major liver vasculature (PMV) even after a full course of neoadjuvant chemotherapy (NAC). In such cases, extreme liver resection can be considered a potential option. AIM To explore whether computer-assisted three-dimensional individualized extreme liver resection is safe and feasible for children with HB who still have PMV after a full course of NAC. METHODS We retrospectively collected data from children with HB who underwent surgical resection at our center from June 2013 to June 2023. We then analyzed the detailed clinical and three-dimensional characteristics of children with HB who still had PMV after a full course of NAC. RESULTS Sixty-seven children diagnosed with HB underwent surgical resection. The age at diagnosis was 21.4 ± 18.8 months, and 40 boys and 27 girls were included. Fifty-nine (88.1%) patients had a single tumor, 39 (58.2%) of which was located in the right lobe of the liver. A total of 47 patients (70.1%) had PRE-TEXT III or IV. Thirty-nine patients (58.2%) underwent delayed resection. After a full course of NAC, 16 patients still had close PMV (within 1 cm in two patients, touching in 11 patients, compressing in four patients, and showing tumor thrombus in three patients). There were 6 patients of tumors in the middle lobe of the liver, and four of those patients exhibited liver anatomy variations. These 16 children underwent extreme liver resection after comprehensive preoperative evaluation. Intraoperative procedures were performed according to the preoperative plan, and the operations were successfully performed. Currently, the 3-year event-free survival of 67 children with HB is 88%. Among the 16 children who underwent extreme liver resection, three experienced recurrence, and one died due to multiple metastases. CONCLUSION Extreme liver resection for HB that is still in close PMV after a full course of NAC is both safe and feasible. This approach not only reduces the necessity for liver transplantation but also results in a favorable prognosis. Individualized three-dimensional surgical planning is beneficial for accurate and complete resection of HB, particularly for assessing vascular involvement, remnant liver volume and anatomical variations.

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“…The sensitivities and specificities of preoperative MR were calculated for 1) diagnosing each POSTTEXT stage; 2) discrimination of stages III and IV (advanced) from those stages I and II (non‐advanced) hepatoblastomas; and 3) annotation factors P and V. The POSTTEXT III and IV tumors were evaluated together here as they are generally considered advanced tumors requiring complex liver resection (e.g., extended hemihepatectomy) or transplantation. It is imperative to accurately identify this subset of cases because extended liver resection carries a high risk of postoperative liver failure due to the small liver remnant, and transplantation may necessitate referral to a specialty liver center 2,3,16–19 …”

Section: Methodsmentioning

confidence: 99%

“…It is imperative to accurately identify this subset of cases because extended liver resection carries a high risk of postoperative liver failure due to the small liver remnant, and transplantation may necessitate referral to a specialty liver center. 2,3,[16][17][18][19] Fleiss kappa test was used to assess the interobservers' agreement for POSTTEXT staging as well as the annotation factors P and V. The levels of agreement for Fleiss kappa values were: 0-0.20 (poor), 0.21-0.40 (fair), 0.41-0.60 (moderate), 0.61-0.80 (substantial), and 0.81-1.00 (excellent). 20 Statistical analysis was performed with MedCalc version 11.6 (MedCalc Software, Mariakerke, Belgium) and R version 4.1.3 (The R Foundation for Statistical Computing).…”

Section: Statisticsmentioning

confidence: 99%

Pediatric Hepatoblastoma After Neoadjuvant Chemotherapy: Diagnostic Performance of MR in Staging POSTTEXT and Vascular Involvement

Gong

Feng

Zhuang

et al. 2023

Magnetic Resonance Imaging

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BackgroundThe assessment of resectability after neoadjuvant chemotherapy of hepatoblastoma is dependent on Post‐Treatment EXTENT of Disease (POSTTEXT) staging and its annotation factors P (portal venous involvement) and V (hepatic venous/inferior vena cava [IVC] involvement), but MR performance in assessing them remains unclear.PurposeTo assess the diagnostic performance of contrast‐enhanced MR imaging for preoperative POSTTEXT staging and diagnosing vascular involvement in terms of annotation factors P and V in pediatric hepatoblastoma following neoadjuvant chemotherapy.Study TypeRetrospective.SubjectsThirty‐five consecutive patients (17 males, median age, 24 months; age range, 6–98 months) with proven hepatoblastoma underwent preoperative MR imaging following neoadjuvant chemotherapy.Field Strength/Sequence3.0 T; T2‐weighted imaging (T2WI), T2WI with fat suppression, diffusion weighted imaging, radial stack‐of‐the‐star/Cartesian 3D Dixon T1‐weighted gradient echo imaging.AssessmentThree radiologists independently assessed the POSTTEXT stages and annotation factors P and V based on the 2017 PRE/POSTTEXT system. The sensitivities and specificities were calculated for 1) diagnosing each POSTTEXT stage; 2) discrimination of stages III and IV (advanced) from those stages I and II (non‐advanced) hepatoblastomas; and 3) annotation factors P and V. The combination of pathologic findings and surgical records served as the reference standard.Statistical TestsSensitivity, specificity, Fleiss kappa test.ResultsThe sensitivity and specificity ranges for discriminating advanced from non‐advanced hepatoblastomas were 73.3%–80.0% and 80.0%–90.0%, respectively. For annotation factor P, they were 66.7%–100.0% and 90.6%, respectively. For factor V, they were 75.0% and 67.7%–83.9%, respectively. There was excellent, substantial, and moderate agreement on POSTTEXT staging (Fleiss kappa = 0.82), factors P (Fleiss kappa = 0.64), and factors V (Fleiss kappa = 0.60), respectively.Data ConclusionMR POSTTEXT provides reliable discrimination between advanced and non‐advanced tumors, and MR has moderate to excellent specificity at identifying portal venous and hepatic venous/IVC involvement.Evidence Level3Technical EfficacyStage 3

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Surgical management in hepatoblastoma: points to take

Cited by 11 publications

References 62 publications

Case Report: ALPPS hepatectomy, an alternative to liver transplantation in central PRETEXT III hepatoblastomas: a case series

Case Report: ALPPS hepatectomy, an alternative to liver transplantation in central PRETEXT III hepatoblastomas: a case series

Computer-assisted three-dimensional individualized extreme liver resection for hepatoblastoma in proximity to the major liver vasculature

Pediatric Hepatoblastoma After Neoadjuvant Chemotherapy: Diagnostic Performance of MR in Staging POSTTEXT and Vascular Involvement

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