Surgical Management of Hepatoblastoma and Recent Advances

Yang, Tianyou; Whitlock, Richard S.; Vasudevan, Sanjeev A.

doi:10.3390/cancers11121944

Cited by 44 publications

(55 citation statements)

References 91 publications

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“…The probability of hepatoblastoma occurring in an infant or young child varies between 0.5 and 2 cases per million children per year. The explanation for this vast difference could be due to differing age groups and the possibility that the low hepatoblastoma values given in recent individual publications originate from "old" statistics, and therefore no longer accurately depict current incidence rates (29,30). Regional peculiarities supposedly play a subordinate role (25).…”

Section: Epidemiologymentioning

confidence: 99%

“…The current therapeutic approach involves three treatment options: (i) pre-and/ or post-operative chemotherapy, (ii) tumorectomy with possible partial liver resection, and (iii) liver transplantation (29). The use of chemotherapies, including platinum compounds for neoadjuvant and adjuvant treatment of hepatoblastomas resulted in a significant improvement in outcome.…”

Section: Therapeutic Considerationsmentioning

confidence: 99%

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Hepatoblastoma

Hager

Sergi

2021

Liver Cancer

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Hepatoblastoma is the most common liver cancer in children aged 3 years and younger. The differential diagnosis of this neoplasm is crucial for the proper management. Recent additions to protocols of the International Society of Pediatric Oncology and Children' s Oncology Group have been key in tackling this oncological disease. This chapter provides an overview of the etiology, pathogenesis, epidemiology, incidence, symptoms, and therapeutic considerations of hepatoblastoma. The diagnostic measures necessary from a surgical point of view and the essential operational and technical considerations for the various stages of hepatoblastoma are discussed.

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Section: Epidemiologymentioning

confidence: 99%

Section: Therapeutic Considerationsmentioning

confidence: 99%

Hepatoblastoma

Hager

Sergi

2021

Liver Cancer

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“…[ 18 ] Due to the impressive liver regenerative capabilities in children, 75% to 85% of the liver parenchyma can be safely resected. [ 26 , 27 ] Ribero and colleagues suggested that TLV measured by CT was highly variable compared with TLV estimated on the correlation existing with the body surface area. [ 28 ] However, there is no widely - accepted estimation formula for children, thus we suggest use future liver remnant/body weight (FLR/BW) as an alternative instrument according to a minimal graft-recipient weight ratio (GRWR) of 0.8% employed in liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

Successful management and technical aspects of major liver resection in children

Jiang

Aizpuru

et al. 2021

Medicine

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Optimal treatment of patients with various types of liver tumors or certain liver diseases frequently demands major liver resection, which remains a clinical challenge especially in children. Eighty seven consecutive pediatric liver resections including 51 (59%) major resections (resection of 3 or more hepatic segments) and 36 (41%) minor resections (resection of 1 or 2 segments) were analyzed. All patients were treated between January 2010 and March 2018. Perioperative outcomes were compared between major and minor hepatic resections. The male to female ratio was 1.72:1. The median age at operation was 20 months (range, 0.33–150 months). There was no significant difference in demographics including age, weight, ASA class, and underlying pathology. The surgical management included functional assessment of the future liver remnant, critical perioperative management, enhanced understanding of hepatic segmental anatomy, and bleeding control, as well as refined surgical techniques. The median estimated blood loss was 40 ml in the minor liver resection group, and 90 ml in major liver resection group ( P < .001). Children undergoing major liver resection had a significantly longer median operative time (80 vs 140 minutes), anesthesia time (140 vs 205 minutes), as well as higher median intraoperative total fluid input (255 vs 450 ml) ( P < .001 for all). Fourteen (16.1%) patients had postoperative complications. By Clavien-Dindo classification, there were 8 grade I, 4 grade II, and 2 grade III-a complications. There were no significant differences in complication rates between groups ( P = .902). Time to clear liquid diet ( P = .381) and general diet ( P = .473) was not significantly different. There was no difference in hospital length of stay (7 vs 7 days, P = .450). There were no 90-day readmissions or mortalities. Major liver resection in children is not associated with an increased incidence of postoperative complications or prolonged postoperative hospital stay compared to minor liver resection. Techniques employed in this study offered good perioperative outcomes for children undergoing major liver resections.

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“…If resection was deemed possible after NACT, children should undergo surgery with minimal delay. Children with HB who remain unresectable after NACT can be candidates for liver transplantation (LT) (37)(38)(39)(40). However, the cost and benefits of performing LT within an epidemic region should be carefully assessed.…”

Section: Patients With Hb Without Covid-19mentioning

confidence: 99%

A narrative review of the challenges and countermeasures in hepatoblastoma management during COVID-19 epidemic

Xu¹,

Zhou²,

Sun³

et al. 2020

Transl Pediatr

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An infectious disease named "coronavirus disease 2019" (COVID-19) currently has brought a threat to global health security and trends to be more and more severe in many countries. It also has introduced great challenges to the diagnosis and management of children with hepatoblastoma (HB). During the COVID-19 pandemic, pediatric surgeons should not only develop personalized treatment plans for HB therapy, but also emphasize the diagnosis, prevention, and treatment of this virus. Children with both HB and COVID-19 are recommended to undertake multidisciplinary assessment. Anti-SARS-CoV-2 therapy may be a preferred treatment for the infected without presenting a surgical emergency. However, emergent operation may be necessary for HB children with concurrent COVID-19 who developed a life-threatening surgical emergency condition. Otherwise, for children with negative virus examination results, treatment advice should be based on the impact of the epidemic and regional economic considerations. A "wait and see" strategy is recommended for children with resectable tumors after new adjuvant chemotherapy treatment (NACT). Assessment of liver transplantation is recommended for children with HB whose tumors cannot be resected after NACT. Children with HB with pulmonary metastasis may have abnormal findings on chest imaging due to COVID-19. Besides, the detailed therapeutic regimens may vary for children with HB with or without an emergency presentation. Based on previous consensus, current research, and the experiences of our hospital, we aim to offer available management plans for the above-mentioned concerns.

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Surgical Management of Hepatoblastoma and Recent Advances

Cited by 44 publications

References 91 publications

Hepatoblastoma

Hepatoblastoma

Successful management and technical aspects of major liver resection in children

A narrative review of the challenges and countermeasures in hepatoblastoma management during COVID-19 epidemic

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