Two-stage laparoscopic resection of giant hepatoblastoma in infants combined with liver partial partition and artery ligation

Abstract

Purpose Laparoscopic resection of giant hepatoblastoma (HB) in children has long been a subject of controversy. Here, a new procedure of two-stage laparoscopic resection of giant HB in infants was firstly reported and the feasibility was discussed. Methods The clinical data of three infants with HB were retrospectively reviewed, all of which received 3–5 cycles of neoadjuvant chemotherapy. Stage 1 laparoscopic selective hepatic artery ligation and liver partial partition were performed. Stage 2 laparoscopic hepatectomy was performed 2 weeks later. Results The results demonstrated that (1) the tumors shrank considerably in size and had relatively clear boundaries after neoadjuvant chemotherapy; (2) after stage 1 surgery, the tumor volume further reduced, while the intratumoral necrosis expanded; (3) 2 weeks later, stage 2 laparoscopic hepatectomy was performed successfully; (4) none of the cases had intraoperative complications such as tumor rupture, air embolism, hemorrhage, biliary fistula, or liver failure, and there was no recurrence or metastasis during follow-up. Conclusions Two-stage laparoscopic hepatectomy associating selective hepatic artery ligation and liver partial partition for HB in infants has the benefits of small invasiveness, fast recovery, improved safety, and high feasibility. However, more cases and longer follow-up are needed to assess its long-term efficacy.

Deploying Indocyanine Green Fluorescence-Guided Navigation System in Precise Laparoscopic Resection of Pediatric Hepatoblastoma

“…Current studies show no significant difference in the 3-year tumor-free survival rate between open surgery and laparoscopy for HB [ 19 , 20 ]. Our previous studies have also shown that laparoscopic techniques are safe and feasible in the treatment of giant HB [ 21 ]. In addition, navigating laparoscopic HB resection with ICG fluorescence is advantageous due to the real-time display of tumor boundaries and small metastases.…”

Recent advances in surgical strategies and liver transplantation for hepatoblastoma

“…As a modified procedure, two‐stage laparoscopic hepatectomy for giant HB with selective hepatic artery ligation and liver partial partition has also been introduced. 47 However, there are reports of rapid tumor recurrence in residual livers after ALPPS in adult and pediatric patients. 48 , 49 Although it is difficult to assess whether the ALPPS procedure played a vital role in recurrence, a potential contribution of the immune response that promotes liver regeneration to rapid tumor growth cannot be ruled out.…”

“…To date, challenging but successful cases, such as modified ALPPS in a small infant (54 days old) with HB, 44 pure laparoscopic 1st stage partial ALPPS, 45 and monosegment 6 ALPPS for a POST‐TEXT IV HB, 46 have been reported. As a modified procedure, two‐stage laparoscopic hepatectomy for giant HB with selective hepatic artery ligation and liver partial partition has also been introduced 47 . However, there are reports of rapid tumor recurrence in residual livers after ALPPS in adult and pediatric patients 48,49 .…”

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

“…The ALPPS (Associating Liver Partition and Portal vein ligation for Staged Hepatectomy) hepatectomy technique, initially described by Schlitt et al in adults in 2012 ( 5 ), has recently been successfully adopted for the management of pediatric patients. Its use has been described in PRETEXT II and PRETEXT III hepatoblastomas of non-central locations ( 3 , 5 – 7 ). Three cases of central location PRETEXT II or III hepatoblastomas in which the ALPPS hepatectomy was successfully employed as an alternative to liver transplantation are being reported for the first time.…”