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Liu J, Xiu W, Duan G, Wang B, Jiang N, Dong Q, Xia N, Lin A. Digital medicine and minimally invasive surgery in pediatric hepatoblastoma: An update. Asian J Surg 2024; 47:2132-2137. [PMID: 38331610 DOI: 10.1016/j.asjsur.2024.01.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/15/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
Hepatoblastoma (HB) is the most common liver malignancy in children, accounting for approximately 60 % of liver tumors in this population. However, the exact cause of HB remains unclear. The combination of surgery and neoadjuvant chemotherapy has significantly improved the overall survival rate of children with HB, increasing it from 40 % in the past to over 70 %. The concept of precise hepatectomy, which aims to achieve the best rehabilitation outcomes with minimal trauma and maximum liver protection, has been widely accepted by hepatobiliary surgeons. This article provides a comprehensive review of the recent advancements in surgical treatment of HB, focusing on digital surgery and minimally invasive techniques.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China; Department of Medical Biology of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Wenli Xiu
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Bao Wang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Nannan Jiang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Qian Dong
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
| | - Nan Xia
- Institute of Digital Medicine and Computer-assisted Surgery of Qingdao University, Qingdao University, Qingdao, China; Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Qingdao, China.
| | - Aiqin Lin
- Department of Medical Biology of Wannan Medical College, Wannan Medical College, Wuhu, China.
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Xiu WL, Liu J, Zhang JL, Wang JM, Wang XF, Wang FF, Mi J, Hao XW, Xia N, Dong Q. Computer-assisted three-dimensional individualized extreme liver resection for hepatoblastoma in proximity to the major liver vasculature. World J Gastrointest Surg 2024; 16:1066-1077. [PMID: 38690040 PMCID: PMC11056661 DOI: 10.4240/wjgs.v16.i4.1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/29/2024] [Accepted: 03/15/2024] [Indexed: 04/22/2024] Open
Abstract
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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Affiliation(s)
- Wen-Li Xiu
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Jing-Li Zhang
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jing-Miao Wang
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xue-Feng Wang
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Fei-Fei Wang
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Shandong College Collaborative Innovation Center of Digital Medicine Clinical Treatment and Nutrition Health, Qingdao University, Qingdao 266003, Shandong Province, China
| | - Jie Mi
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xi-Wei Hao
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Nan Xia
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Shandong College Collaborative Innovation Center of Digital Medicine Clinical Treatment and Nutrition Health, Qingdao University, Qingdao 266003, Shandong Province, China
| | - Qian Dong
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Shandong College Collaborative Innovation Center of Digital Medicine Clinical Treatment and Nutrition Health, Qingdao University, Qingdao 266003, Shandong Province, China
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Yu L, Xiu W, Yue A, Hao X, Jiang Z, Wu J, Dong Q. Cholangiocarcinoma identified in perforated choledochal cyst in a 3-year-old boy. BMC Pediatr 2024; 24:243. [PMID: 38580968 PMCID: PMC10996131 DOI: 10.1186/s12887-024-04709-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/13/2024] [Indexed: 04/07/2024] Open
Abstract
Cholangiocarcinoma in patients with Choledochal cysts is rare in childhood; however, it seriously affects the prognosis of the disease. The key to addressing this situation lies in completely removing the extrahepatic cyst. We herein present a case report of a 3-year-old boy with cholangiocarcinoma associated with a choledochal cyst (CDC). Preoperative 3D simulation, based on CT data, played an important role in the treatment of this patient.
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Affiliation(s)
- Lun Yu
- Department of Paediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Wenli Xiu
- Department of Paediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Aimei Yue
- Department of Paediatrics, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Xiwei Hao
- Department of Paediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Zhong Jiang
- Department of Paediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Jie Wu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Qian Dong
- Department of Paediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, China.
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Liu J, Xiu W, Lin A, Duan G, Jiang N, Wang B, Wang F, Dong Q, Xia N. Can Hisense computer-assisted surgery system (Hisense CAS) improve anatomy teaching in pediatric liver surgery? Surg Radiol Anat 2024; 46:117-124. [PMID: 38189912 DOI: 10.1007/s00276-023-03277-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE This study aimed to investigate the effectiveness of the Hisense computer-assisted surgery system (CAS) in teaching pediatric liver surgical anatomy. METHODS The research subjects were residents who underwent standardized training at the Department of Pediatric Surgery at Yijishan Hospital of Wannan Medical College from May 2022 to May 2023. RESULTS The study recruited a total of 62 students, with 31 students assigned to the Hisense CAS group (12 males and 19 females) and the remaining 31 students serving as controls (Control group, 15 males and 16 females). There were no significant differences in baseline characteristics observed between the two groups. This study found that the average scores of the Hisense CAS teaching group in the liver surgery evaluations were higher than those of the control group. Specifically, the Hisense CAS group had an average score of 84.25 ± 5.70 points in the liver surgery knowledge test, 77.10 ± 8.12 points in the image reading test, and 70.58 ± 8.79 points in the surgical simulation test, while the traditional teaching group had average scores of 73.45 ± 6.12 points, 69.81 ± 6.05 points, and 66.42 ± 6.61 points, respectively; the differences between the two groups were statistically significant (P < 0.05). Furthermore, this study also found that the Hisense CAS teaching model resulted in significantly better teaching satisfaction on the part of the residents in terms of standardized teaching for physicians in pediatric liver surgical anatomy. CONCLUSION In conclusion, this study demonstrated greater satisfaction of the residents with the use of 3D reconstruction added to traditional teaching sessions and better performance during the posttraining evaluation.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, No. 308, Ningxia Road, Shinan District, Qingdao, 266071, Shandong, China
| | - Wenli Xiu
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, No. 308, Ningxia Road, Shinan District, Qingdao, 266071, Shandong, China
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, No. 16, Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China
| | - Aiqin Lin
- Department of Medical Biology of Wannan Medical College, Wannan Medical College, Wuhu, 241002, China
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Nannan Jiang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Bao Wang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Feifei Wang
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, No. 308, Ningxia Road, Shinan District, Qingdao, 266071, Shandong, China.
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, No. 16, Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China.
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
| | - Qian Dong
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, No. 308, Ningxia Road, Shinan District, Qingdao, 266071, Shandong, China.
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, No. 16, Jiangsu Road, Shinan District, Qingdao, 266000, Shandong, China.
| | - Nan Xia
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, No. 308, Ningxia Road, Shinan District, Qingdao, 266071, Shandong, China.
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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