1
|
Akhaladze DG, Rabaev GS, Tverdov IV, Merkulov NN, Uskova NG, Talypov SR, Krivonosov AA, Grachev NS. Central Liver Segments Resections vs Extended Hepatectomies in Children: Single-center Experience. J Pediatr Surg 2024:161927. [PMID: 39368854 DOI: 10.1016/j.jpedsurg.2024.161927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 08/26/2024] [Accepted: 09/07/2024] [Indexed: 10/07/2024]
Abstract
BACKGROUND Central liver segments resection (CLSR) still is not widely used in pediatric surgery due to its technical difficulty, whereas this procedure is widely spread as a parenchyma sparing approach of centrally located liver tumors in adults. The aim of this study is to analyze the outcomes of CLSR in comparison with extended hepatectomy (EH) in children with different liver tumors. METHODS A single-center retrospective analysis of patients who received CLSR (n = 14) and EH (n = 44) from June 2017 to December 2023 was applied. Patient's characteristics, preoperative, intra- and postoperative data were compared between 2 groups. RESULTS Preoperative CT-volumetry showed that future liver remnant volume was higher in CLSR group compared to EH (FLR-V; (54 ± 29 (40-91) % vs 40 ± 12 (17-73) %, p = 0.016). The intraoperative blood loss (200 [90-1150] (20-3000) ml vs 100 [30-275] (10-9000) ml, p = 0.088) and transfusion volume (310 [85-590] (0-1860) ml vs 150 [0-310] (0-4770) ml, p = 0.484) were similar in both groups, while operation time was longer in CLSR group (420 [320-595] (145-785) min vs 280 [203-390] (125-710) min), p = 0.011). There was no difference in biliary leakage (3 (21.4 %) vs 12 (27.3 %); p = 0.479), other complications (4 (28.6 %) vs 5 (11.4 %), p = 0.198) and complications ≥ IIIb by Clavien-Dindo (2 (14.3 %) vs 8 (18.2 %), p = 0.385) postoperatively. CONCLUSION CLSRs allow to preserve more healthy liver parenchyma compared to EH with similar intraoperative and postoperative outcomes. «Extended mesohepatectomy» allows to achieve R0 resection when central liver tumor extends on the left lateral and/or right posterior section. TYPE OF STUDY Retrospective Comparative Study (Level of Evidence III).
Collapse
Affiliation(s)
- Dmitry G Akhaladze
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Gavriil S Rabaev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation; University Medical Centre Corporate Fund, National Research Center for Maternal and Child Health, 010000, Astana, 32 Turan Str., Kazakhstan.
| | - Ivan V Tverdov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Nikolay N Merkulov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Natalia G Uskova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Sergey R Talypov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Anatoliy A Krivonosov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| | - Nikolay S Grachev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 117997, Moscow, 1 Samory Mashela Str., Russian Federation
| |
Collapse
|
2
|
Ho HT, Mai TH, Nguyen TX, Nguyen KHT, Pham NH, Nguyen HS. Central Hepatectomy in a 6-Month-Old Child with Hepatoblastoma following Chemotherapy. Case Rep Oncol 2021; 14:874-880. [PMID: 34267635 PMCID: PMC8261264 DOI: 10.1159/000516800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
A hepatoblastoma in a 6-month-old child was initially considered unresectable because of diffuse liver involvement. The patient received 4 courses of cisplatin with an interval time of 2 weeks. A computed tomography scan after 4 courses of chemotherapy showed shrinking of the tumor, which made it resectable, and the tumor was removed by central hepatectomy. The patient was able to eat a regular diet on the fourth day and was sent home on the seventh day, after the operation. The pediatric oncologist followed the patient with liver ultrasonography and alpha-fetoprotein and administered 2 more cycles of cisplatin.
Collapse
Affiliation(s)
- Huu Thien Ho
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
| | - Trung Hieu Mai
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
| | - Thanh Xuan Nguyen
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
| | | | - Nhu Hien Pham
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
| | - Huu Son Nguyen
- Pediatric Center, Hue Central Hospital, Hue City, Vietnam
| |
Collapse
|
3
|
Guérin F, Gauthier F, Martelli H, Fabre M, Baujard C, Franchi S, Branchereau S. Outcome of central hepatectomy for hepatoblastomas. J Pediatr Surg 2010; 45:555-63. [PMID: 20223320 DOI: 10.1016/j.jpedsurg.2009.09.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 09/21/2009] [Accepted: 09/22/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Central hepatoblastomas (CHBL) involving liver segments (IV + V) or (IV + V + VIII) are in contact with the portal bifurcation. Their resection may be achieved by central hepatectomy (CH) with thin resection margins on both sides of the liver pedicle, by extended right or left hepatectomy with thin resection margins on one side, or by liver transplantation with thick free margins. The aim of this study is to assess the operative and postoperative outcome of CH for hepatoblastoma. METHODS This was a retrospective monocentric study of 9 patients who underwent CH for CHBL between 1996 and 2008. RESULTS The operative time was 4 hours 50 minutes (2 hours 20 minutes to 7 hours), vascular clamping lasted 30 minutes (0-90 minutes), and the amount of blood cell transfusion was 250 mL (0-1800 mL). Two patients had biliary leakage requiring percutaneous drainage. Median follow-up time was 27 months (14-120 months). All of 8 nonmetastatic patients are alive and disease-free; 1 metastatic patient died of recurrent metastases at last follow-up. Although 3 of 9 patients had surgical margins less than 1 mm, none, including the patients who died from metastases, had local recurrence. CONCLUSIONS Our study demonstrates the feasibility of CH for CHBL without operative mortality or local recurrence. Central hepatectomy is an alternative to extensive liver resections in selected patients.
Collapse
Affiliation(s)
- Florent Guérin
- Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, University Paris XI., Le Kremlin-Bicêtre, France.
| | | | | | | | | | | | | |
Collapse
|
4
|
Roebuck DJ, Aronson D, Clapuyt P, Czauderna P, de Ville de Goyet J, Gauthier F, Mackinlay G, Maibach R, McHugh K, Olsen OE, Otte JB, Pariente D, Plaschkes J, Childs M, Perilongo G. 2005 PRETEXT: a revised staging system for primary malignant liver tumours of childhood developed by the SIOPEL group. Pediatr Radiol 2007; 37:123-32; quiz 249-50. [PMID: 17186233 PMCID: PMC1805044 DOI: 10.1007/s00247-006-0361-5] [Citation(s) in RCA: 203] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 10/29/2006] [Indexed: 12/17/2022]
Abstract
Over the last 15 years, various oncology groups throughout the world have used the PRETEXT system for staging malignant primary liver tumours of childhood. This paper, written by members of the radiology and surgery committees of the International Childhood Liver Tumor Strategy Group (SIOPEL), presents various clarifications and revisions to the original PRETEXT system.
Collapse
Affiliation(s)
- Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|