Reynolds M, Douglass E C, Finegold M, Cantor A, Glicksman A
Children's Memorial Hospital, Chicago, IL.
J Pediatr Surg. 1992 Aug;27(8):1080-3; discussion 1083-4. doi: 10.1016/0022-3468(92)90564-n.
The surgical evaluation and management of children with hepatoblastoma has changed with recent advances in imaging modalities and preoperative chemotherapy. Pediatric Oncology Group (POG) Study no. 8697 has followed 63 patients with hepatoblastoma from 1986 to 1991. Twenty-six patients underwent primary tumor resection followed by chemotherapy consisting of cisplatin, vincristine, and 5-fluorouracil (group I). Thirty-seven patients with "unresectable" tumors received preoperative chemotherapy. Twenty-nine of these patients responded to chemotherapy and 26 underwent delayed surgical resection (group II). Eight patients had an inadequate response to chemotherapy; two have had successful liver transplantation and six are dead of disease progression. "Unresectable tumor" involved both liver lobes (25 patients), encased the inferior vena cava (2), involved adjacent tissues (1), involved the hepatic veins (2), or was deemed too large for safe resection (7). Two patients had distant metastases. The reason for an unresectable designation was not reported in five patients. The determination for an unresectable designation included exploratory laparotomy in 14 patients, angiogram in 7, computed tomography scan in 20, and magnetic resonance imaging in 3 patients. Operative times and transfusion requirements were similar in both groups. Perioperative complications were higher in patients in group II. There was no mortality and only minor morbidity associated with chemotherapy in each group. In both groups 77% of the patients are in complete remission after 13 to 54 months. Preoperative chemotherapy can allow successful resection of initially "unresectable" hepatoblastoma. Primary resection that may result in exsanguination should be postponed and chemotherapy given.
随着影像技术和术前化疗的最新进展，肝母细胞瘤患儿的外科评估和治疗发生了变化。儿科肿瘤学组（POG）的8697号研究在1986年至1991年期间对63例肝母细胞瘤患儿进行了随访。26例患者接受了原发肿瘤切除，随后接受由顺铂、长春新碱和5-氟尿嘧啶组成的化疗（第一组）。37例“无法切除”肿瘤的患者接受了术前化疗。其中29例患者对化疗有反应，26例接受了延迟手术切除（第二组）。8例患者对化疗反应不佳；2例成功进行了肝移植，6例死于疾病进展。“无法切除的肿瘤”累及双侧肝叶（25例）、包绕下腔静脉（2例）、累及相邻组织（1例）、累及肝静脉（2例）或因肿瘤过大认为无法安全切除（7例）。2例患者有远处转移。5例患者未报告无法切除的原因。确定无法切除的诊断方法包括14例患者进行了剖腹探查、7例进行了血管造影、20例进行了计算机断层扫描、3例进行了磁共振成像。两组的手术时间和输血需求相似。第二组患者围手术期并发症较高。每组化疗相关的死亡率均为零，仅伴有轻微的发病率。两组中77%的患者在13至54个月后完全缓解。术前化疗可使最初“无法切除”的肝母细胞瘤成功切除。可能导致大出血的一期切除应推迟并给予化疗。
