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Sakamoto S, Harikrishnan S, Uchida H, Yanagi Y, Fukuda A, Kasahara M. Liver transplantation for pediatric liver malignancies. Liver Transpl 2024:01445473-990000000-00440. [PMID: 39172014 DOI: 10.1097/lvt.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 08/15/2024] [Indexed: 08/23/2024]
Abstract
In the last few decades, collaboration between international pediatric oncology groups has resulted in significant improvement in survival after liver transplantation (LT) for pediatric liver tumors, and LT has become the accepted standard of care for unresectable pediatric liver tumors-either living donor liver transplantation or deceased donor liver transplantation. Hepatoblastoma and HCC are the common pediatric liver malignancies treated by LT, and LT is now the accepted treatment modality for unresectable nonmetastatic cases. The long-term survival rate is more than 80% in hepatoblastoma transplants. Furthermore, with the advent of living donor liver transplantation, the waitlist mortality, availability of a better graft quality with shorter ischemic times, and performance of LT with the appropriate timing between chemotherapy have all improved. Up to 80% of pediatric HCCs are unresectable, and studies have shown that LT for pediatric HCC has better outcomes than liver resection. Furthermore, LT has also shown better results than liver resection for cases of HCC not meeting Milan criteria. Given the rarity of pediatric liver malignancies and challenges in optimal management, a multidisciplinary treatment approach, research models building on what is already known, and consideration of newer treatment modalities are required for further improving the treatment of pediatric liver malignancies.
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Affiliation(s)
- Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
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2
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Riehle KJ, Vasudevan SA, Bondoc A, Cuenca AG, Garnier H, Kastenberg Z, Roach J, Weldon CB, Karpelowsky J, Hishiki T, Tiao G. Surgical management of liver tumors. Pediatr Blood Cancer 2024:e31155. [PMID: 38953150 DOI: 10.1002/pbc.31155] [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: 04/22/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024]
Abstract
Two percent of pediatric malignancies arise primarily in the liver; roughly 60% of these cancers are hepatoblastoma (HB). Despite the rarity of these cases, international collaborative efforts have led to the consistent histological classification and staging systems, which facilitate ongoing clinical trials. Other primary liver malignancies seen in children include hepatocellular carcinoma (HCC) with or without underlying liver disease, fibrolamellar carcinoma (FLC), undifferentiated embryonal sarcoma of the liver (UESL), and hepatocellular neoplasm not otherwise specified (HCN-NOS). This review describes principles of surgical management of malignant pediatric primary liver tumors, within the context of comprehensive multidisciplinary care.
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Affiliation(s)
- Kimberly J Riehle
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | | | - Alexander Bondoc
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alex G Cuenca
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Zachary Kastenberg
- Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | | | | | | | | | - Gregory Tiao
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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3
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Kastenberg ZJ, Short SS, Riehle KJ, Utria A, Lautz TB, Ott KC, Murphy AJ, Mansfield S, Lal DR, Hallis B, Murphy JT, Roach JP, Polites SF, Beckhorn C, Tracy ET, Fialkowski EA, Seemann NM, Bütter AM, Rich BS, Glick RD, Bondoc AJ, Ofori-Atta BS, Presson AP, Chen SY, Zamora AK, Kim ES, Vasudevan S, Rinehardt HN, Malek MM, Lapidus-Krol E, Putra J, Superina RA, Langham MR, Meyers RL, Tiao G, Dasgupta R, Baertschiger R. Management of undifferentiated embryonal sarcoma of the liver: A Pediatric Surgical Oncology Research Collaborative study. Pediatr Blood Cancer 2024; 71:e30975. [PMID: 38556718 PMCID: PMC11039358 DOI: 10.1002/pbc.30975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/14/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Undifferentiated embryonal sarcoma of the liver (UESL) is a rare tumor for which there are few evidence-based guidelines. The aim of this study was to define current management strategies and outcomes for these patients using a multi-institutional dataset curated by the Pediatric Surgical Oncology Research Collaborative. METHODS Data were collected retrospectively for patients with UESL treated across 17 children's hospitals in North America from 1989 to 2019. Factors analyzed included patient and tumor characteristics, PRETEXT group, operative details, and neoadjuvant/adjuvant regimens. Event-free and overall survival (EFS, OS) were the primary and secondary outcomes, respectively. RESULTS Seventy-eight patients were identified with a median age of 9.9 years [interquartile range [IQR): 7-12]. Twenty-seven patients underwent resection at diagnosis, and 47 patients underwent delayed resection, including eight liver transplants. Neoadjuvant chemotherapy led to a median change in maximum tumor diameter of 1.6 cm [IQR: 0.0-4.4] and greater than 90% tumor necrosis in 79% of the patients undergoing delayed resection. R0 resections were accomplished in 63 patients (81%). Univariate analysis found that metastatic disease impacted OS, and completeness of resection impacted both EFS and OS, while multivariate analysis revealed that R0 resection was associated with decreased expected hazards of experiencing an event [hazard ratio (HR): 0.14, 95% confidence interval (CI): 0.04-0.6]. At a median follow-up of 4 years [IQR: 2-8], the EFS was 70.0% [95% CI: 60%-82%] and OS was 83% [95% CI: 75%-93%]. CONCLUSION Complete resection is associated with improved survival for patients with UESL. Neoadjuvant chemotherapy causes minimal radiographic response, but significant tumor necrosis.
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Affiliation(s)
- Zachary J. Kastenberg
- Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, UT
| | - Scott S. Short
- Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, UT
| | - Kimberly J. Riehle
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Alan Utria
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Timothy B. Lautz
- Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Katherine C. Ott
- Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Dave R. Lal
- Children’s Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Brian Hallis
- Children’s Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Joseph T. Murphy
- Children’s Health Specialty Center, University of Texas – Southwestern Medical Center, Dallas, TX
| | - Jonathan P. Roach
- Children’s Hospital Colorado, University of Colorado School of Medicine, Denver, CO
| | | | - Catherine Beckhorn
- Duke Children’s Health Center, Duke University School of Medicine, Durham, NC
| | - Elisabeth T. Tracy
- Duke Children’s Health Center, Duke University School of Medicine, Durham, NC
| | | | - Natashia M. Seemann
- Children’s Hospital London Health Sciences Centre, Western University, London, ON
| | - Andreana M. Bütter
- Children’s Hospital London Health Sciences Centre, Western University, London, ON
| | - Barrie S. Rich
- Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine, New Hyde Park, NY
| | - Richard D. Glick
- Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine, New Hyde Park, NY
| | - Alex J. Bondoc
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Blessing S. Ofori-Atta
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Angela P. Presson
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Stephanie Y. Chen
- Children’s Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA
| | - Abigail K. Zamora
- Children’s Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA
| | - Eugene S. Kim
- Children’s Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA
| | | | - Hannah N. Rinehardt
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Marcus M. Malek
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Eveline Lapidus-Krol
- The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON
| | - Juan Putra
- Department of Pathology, Boston Children’s Hospital, Boston, MA
| | - Riccardo A. Superina
- Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Rebecka L. Meyers
- Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, UT
| | - Greg Tiao
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Roshni Dasgupta
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Reto Baertschiger
- The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON
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Chongo G, Soldera J. Use of machine learning models for the prognostication of liver transplantation: A systematic review. World J Transplant 2024; 14:88891. [PMID: 38576762 PMCID: PMC10989468 DOI: 10.5500/wjt.v14.i1.88891] [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: 10/13/2023] [Revised: 11/08/2023] [Accepted: 12/11/2023] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Liver transplantation (LT) is a life-saving intervention for patients with end-stage liver disease. However, the equitable allocation of scarce donor organs remains a formidable challenge. Prognostic tools are pivotal in identifying the most suitable transplant candidates. Traditionally, scoring systems like the model for end-stage liver disease have been instrumental in this process. Nevertheless, the landscape of prognostication is undergoing a transformation with the integration of machine learning (ML) and artificial intelligence models. AIM To assess the utility of ML models in prognostication for LT, comparing their per formance and reliability to established traditional scoring systems. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a thorough and standardized literature search using the PubMed/MEDLINE database. Our search imposed no restrictions on publication year, age, or gender. Exclusion criteria encompassed non-English stu dies, review articles, case reports, conference papers, studies with missing data, or those exhibiting evident methodological flaws. RESULTS Our search yielded a total of 64 articles, with 23 meeting the inclusion criteria. Among the selected studies, 60.8% originated from the United States and China combined. Only one pediatric study met the criteria. Notably, 91% of the studies were published within the past five years. ML models consistently demonstrated satisfactory to excellent area under the receiver operating characteristic curve values (ranging from 0.6 to 1) across all studies, surpassing the performance of traditional scoring systems. Random forest exhibited superior predictive capa bilities for 90-d mortality following LT, sepsis, and acute kidney injury (AKI). In contrast, gradient boosting excelled in predicting the risk of graft-versus-host disease, pneumonia, and AKI. CONCLUSION This study underscores the potential of ML models in guiding decisions related to allograft allocation and LT, marking a significant evolution in the field of prognostication.
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Affiliation(s)
- Gidion Chongo
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
| | - Jonathan Soldera
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
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5
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Lin WY, Wu KH, Chen CY, Guo BC, Chang YJ, Lin MJ, Wu HP. Treatment of Undifferentiated Embryonal Sarcoma of the Liver in Children. Cancers (Basel) 2024; 16:897. [PMID: 38473259 DOI: 10.3390/cancers16050897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Undifferentiated embryonal sarcoma of the liver is a rare mesenchymal tumor with a highly malignant potential. It occurs almost exclusively in the pediatric population and typically has a poor outcome. Although previous studies have reported dismal prognoses, recent advances in combined treatment modalities, e.g., surgery and chemotherapy, have given cause for optimism. Even in those diseases not amenable to complete surgical resection or refractory diseases, other treatment modalities, such as liver transplant, have yielded promising results. This paper provides a review of the current treatment modalities for hepatic undifferentiated embryonal sarcoma in children.
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Affiliation(s)
- Wen-Ya Lin
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Kang-Hsi Wu
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 408, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 408, Taiwan
| | - Chun-Yu Chen
- Department of Emergency Medicine, Tungs' Taichung Metro Harbor Hospital, Taichung 43503, Taiwan
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356006, Taiwan
| | - Bei-Cyuan Guo
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70142, Taiwan
| | - Yu-Jun Chang
- Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Mao-Jen Lin
- Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung 427213, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
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Bauzon J, Froehlich M, Dadon N, Morris D, Chang S. Outcomes of Primary Tumor Excision do not Differ from Non-Resection Methods in Pediatric Mesenchymal Hamartoma of the Liver: A Rapid Systematic Review. J Pediatr Surg 2023; 58:2356-2361. [PMID: 37775408 DOI: 10.1016/j.jpedsurg.2023.08.012] [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: 07/07/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND To conduct a rapid systematic review comparing the outcomes of primary tumor resection versus non-resection on patients with hepatic mesenchymal hamartoma. METHODS We searched the Ovid MEDLINE, EMBASE, Scopus, PubMed, Web of Science, and Google Scholar databases from January 1, 2000 to March 31, 2022. Studies that described cases of hepatic mesenchymal hamartoma, including management and outcomes, were included. RESULTS 62 articles met inclusion criteria with 95 cases in total. Patients were assigned to the primary tumor resection (n = 85) or non-resection (n = 10) cohort based on the described management. Similar rates of morbidity (17% vs 20%) and mortality (6 vs 10%) were identified between cohorts. There were no differences in sex, liver lobe involvement, or tumor size among study groups. CONCLUSIONS Complete tumor resection should remain the gold standard for hepatic mesenchymal hamartomas when an adequate liver remnant exists. Reports of non-resected tumors demonstrating spontaneous regression or stability with watchful waiting have poor long term follow-up and have inadequate evidence of a true mesenchymal hamartoma diagnosis. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Justin Bauzon
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA; Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Mary Froehlich
- Department of General Surgery, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | - Noam Dadon
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | - Desiree Morris
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | - Shirong Chang
- Division of Pediatric Surgery, Department of General Surgery, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
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7
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Kastenberg ZJ, Baertschiger RM, Cuenca AG, Galvan NTN, Lemoine CP, Roach JP, Walther AE, Dunn SP, Goss JA, Healey PJ, Karpelowsky J, Kim ES, Langham MR, Meyers RL, Superina RA, Tiao GM, Weldon CB, Bondoc AJ, Riehle KJ, Vasudevan SA. Critical elements of pediatric liver cancer surgery. Semin Pediatr Surg 2023; 32:151340. [PMID: 38008042 DOI: 10.1016/j.sempedsurg.2023.151340] [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] [Indexed: 11/28/2023]
Abstract
The appropriate management of pediatric liver malignancies, primarily hepatoblastoma and hepatocellular carcinoma, requires an in depth understanding of contemporary preoperative risk stratification, experience with advanced hepatobiliary surgery, and a good relationship with one's local or regional liver transplant center. While chemotherapy regimens have become more effective, operative indications more well-defined, and overall survival improved, the complexity of liver surgery in small children provides ample opportunity for protocol violation, inadequate resection, and iatrogenic morbidity. These guidelines represent the distillation of contemporary literature and expert opinion as a means to provide a framework for preoperative planning and intraoperative decision-making for the pediatric surgeon.
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Affiliation(s)
- Zachary J Kastenberg
- University of Utah School of Medicine/Primary Children's Hospital, Salt Lake City, UT 84113, USA
| | | | | | | | - Caroline P Lemoine
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | | | - Ashley E Walther
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Stephen P Dunn
- Nemours Children Hospital Delaware, Wilmington, DE 19803, USA
| | - John A Goss
- Texas Children's Hospital / Baylor College of Medicine, Houston, TX 77030, USA
| | | | | | - Eugene S Kim
- Cedars-Sinai Guerin Children's, Los Angeles, CA 90048, USA
| | - Max R Langham
- St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Rebecka L Meyers
- University of Utah School of Medicine/Primary Children's Hospital, Salt Lake City, UT 84113, USA
| | - Riccardo A Superina
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Greg M Tiao
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | | | - Alex J Bondoc
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | | | - Sanjeev A Vasudevan
- Texas Children's Hospital / Baylor College of Medicine, Houston, TX 77030, USA.
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8
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Betoret-Benavente L, Rodríguez-Laiz GP, Melgar-Requena P, Ruiz-López J, Alcázar-López CF, Villodre-Tudela C, Ramia-Ángel JM. Hepatic undifferentiated embryonal sarcoma in a young adult. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:199-200. [PMID: 35760198 DOI: 10.1016/j.gastrohep.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Affiliation(s)
| | - Gonzalo P Rodríguez-Laiz
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - Paola Melgar-Requena
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - Joaquín Ruiz-López
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España
| | - Cándido F Alcázar-López
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - Celia Villodre-Tudela
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - José Manuel Ramia-Ángel
- Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España; Universidad Miguel Hernández, Alicante, España
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9
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Fuchs J, Ruping F, Murtha-Lemekhova A, Kessler M, Günther P, Mehrabi A, Hoffmann K. Comparison of transection techniques in pediatric major hepatectomy: a matched pair analysis. HPB (Oxford) 2023; 25:593-601. [PMID: 36882355 DOI: 10.1016/j.hpb.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Evidence on safety and efficacy of different liver transection techniques in pediatric major hepatectomy is completely lacking, as no study has been conducted so far. The use of stapler hepatectomy has never before been reported in children. METHODS Three liver transection techniques were compared: (1) ultrasonic dissector (CUSA), (2) tissue sealing device (LigaSure™), and (3) stapler hepatectomy. All pediatric hepatectomies performed at a referral center in a 12-year study period were analyzed, patients were pair-matched in a 1:1:1-fashion. Intraoperative weight-adjusted blood loss, operation time, use of inflow occlusion, liver injury (peak-transaminase levels), postoperative complications (CCI), and long-term outcome were compared. RESULTS Of 57 pediatric liver resections, 15 patients were matched as triples based on age, weight, tumor stage, and extent of resection. Intraoperative blood loss was not significantly different between the groups (p = 0.765). Stapler hepatectomy was associated with significantly shorter operation time (p = 0.028). Neither postoperative death nor bile leakage occurred, and no reoperation due to hemorrhage was needed in any patient. CONCLUSION This is the first comparison of transection techniques in pediatric liver resection and the first report on stapler hepatectomy in children. All three techniques can be safely applied and may harbor individual advantages in pediatric hepatectomy each.
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Affiliation(s)
- Juri Fuchs
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Germany.
| | - Fabian Ruping
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Division of Pediatric Surgery, Germany
| | | | - Markus Kessler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Division of Pediatric Surgery, Germany
| | - Patrick Günther
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Division of Pediatric Surgery, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Germany
| | - Katrin Hoffmann
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Germany
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10
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Deploying Indocyanine Green Fluorescence-Guided Navigation System in Precise Laparoscopic Resection of Pediatric Hepatoblastoma. Cancers (Basel) 2022; 14:cancers14246057. [PMID: 36551543 PMCID: PMC9775977 DOI: 10.3390/cancers14246057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/29/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Hepatoblastoma (HB) is the most common form of liver cancer in children. To date, complete tumor resection is still the gold standard for treating HB. Indocyanine green (ICG) has been identified as a sensitive adjunct that is highly effective in the identification and surgical management of local and metastatic HB. It has thus becomes an increasingly popular choice among surgeons in HB resection surgeries that are fluorescence-guided. However, laparotomy remains the preferred choice in most cases since the applications and limitations of fluorescence-guided laparoscopic surgery in treating HB remain unclear. In this study, the characteristics and outcomes of laparoscopic HB resections that were guided by intraoperative ICG fluorescent imaging were investigated. Methods: Seven HB patients underwent ICG-guided laparoscopic HB resection surgery from August 2019 to December 2021. ICG was intravenously administered to the patients at a dosage of 0.5 mg/kg 48 h prior to the scheduled operation. During operation, tumor localization and resection boundary were guided by fluorescence visualization. The data on surgical and clinical features were collected retrospectively. Results: The resection area and tumor boundary could be clearly viewed in real-time under the ICG fluorescence imaging navigation system during operation, except for one patient who had received interventional chemoembolization before surgery. The image produced by laparoscopic fluorescence navigation was clear since it was not affected by ambient light. All tumors were completely resected as confirmed by negative margins for HB during postoperative pathological examination. No residual or recurrence were also found through computed tomography during follow-up visits from 9 to 37 months. Conclusions: ICG fluorescence-guided laparoscopic surgery is safe and effective in treating HB due to its ability to provide clear information on tumor localization and delineate tumor margins in real-time.
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11
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Chojniak R, Boaventura C. Invited Commentary: Diagnosis of Pediatric Liver Lesions. Radiographics 2022; 43:e220186. [DOI: 10.1148/rg.220186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rubens Chojniak
- From the Department of Imaging, A. C. Camargo Cancer Center, Professor Antonio Prudente 211, São Paulo, SP 01509-010, Brazil
| | - Camila Boaventura
- From the Department of Imaging, A. C. Camargo Cancer Center, Professor Antonio Prudente 211, São Paulo, SP 01509-010, Brazil
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12
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Castle JT, Levy BE, Rodeberg DA. Abdominal Tumors. Surg Clin North Am 2022; 102:715-737. [DOI: 10.1016/j.suc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Advocating for the surgical needs of children with cancer. J Pediatr Surg 2022; 57:959-966. [PMID: 35331552 DOI: 10.1016/j.jpedsurg.2022.01.050] [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: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 11/22/2022]
Abstract
Outcomes have improved significantly over the last 60 years for children with cancer. However, one consequence of improved survival is that many patients are now living with the long-term consequences of therapy. Pediatric surgeons can impact both the oncologic outcomes and morbidities of therapy. Therefore, it is incumbent upon us to be considerate, informed, and introspective about what we do as surgeons.
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14
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Fanelli MCA, Guilhen JCS, Duarte AAB, de Souza FKM, Cypriano MDS, Caran EMM, Lederman HM, de Seixas Alves MT, Abib SDCV. Management of Pediatric Tumors With Vascular Extension. Front Pediatr 2021; 9:753232. [PMID: 35059362 PMCID: PMC8764352 DOI: 10.3389/fped.2021.753232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Pediatric tumors can present with vascular extension to the inferior vena cava and right atrium, which impacts the surgical strategy and can be challenging during surgical treatment. Wilms tumor (WT) is the most common retroperitoneal tumor that can present with vascular extension, but also adrenal tumors, clear cell tumors from the kidney, and hepatoblastomas can present with this situation. Surgical aims include obtaining complete tumor resection without risk for patients, to avoid severe bleeding, cardiac arrest, and embolization, and to avoid cardiac bypass if possible. Objective: To describe and discuss the surgical strategies to deal with pediatric tumors with vascular extension and propose a protocol. Method: Retrospectivly review the experience of treating patients with vascular extension in a single institution, describing different scenarios and a decision making fluxogram based on the preoperative evaluation regarding the surgical techniques and the need for cardiac bypass that are adequate for each situation. Image studies are important to guide the surgical strategy. Depending on the quality of image available, computerized tomography (CT) or magnetic resonance imaging (MRI) can be enough to give the information needed for surgical decisions. Ultrasonography (US) with Doppler is helpful to confirm diagnosis and describes factors to guide the adequate surgical strategy, like the upper level extension and presence or absence of blood flow around the thrombus. Neoadjuvant chemotherapy is indicated in most cases, in order to reduce the upper level of extension (and avoid the need for cardiac bypass) and to lower the risk of embolization. The approach is based on the upper level of the thrombus and can include cavotomy or cavectomy, sometimes with cardiac bypass and cardiac arrest with hypothermia, when the thrombus reaches the diaphragmatic level or above. Pathology analysis of the thrombus can guide staging and the need for radiotherapy postoperatively. Results: A decision making fluxogram protocol is presented focusing on the surgical treatment of such condition. Conclusion: Surgery strategy is highly impacted by the presence of vascular extension in pediatric tumors. Surgeons should be aware of potential complications and how to prevent them. Such cases should be treated in reference centers.
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Affiliation(s)
- Mayara Caroline Amorim Fanelli
- Department of Pediatric Surgery, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | | | - Alexandre Alberto Barros Duarte
- Department of Pediatric Surgery, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | | | - Monica Dos Santos Cypriano
- Department of Pediatric Oncology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | - Eliana Maria Monteiro Caran
- Department of Pediatric Oncology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | - Henrique Manoel Lederman
- Department of Pediatric Radiology, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil
| | - Maria Teresa de Seixas Alves
- Department of Pediatric Surgery, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil.,Department of Pediatric Pathology, Federal University of São Paulo, São Paulo, Brazil
| | - Simone de Campos Vieira Abib
- Department of Pediatric Surgery, Pediatric Oncology Institute, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, Brazil.,Department of Pediatric Surgery, Federal University of São Paulo, São Paulo, Brazil
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