Xiu Wen-Li, Liu Jie, Zhang Jing-Li, Wang Jing-Miao, Wang Xue-Feng, Wang Fei-Fei, Mi Jie, Hao Xi-Wei, Xia Nan, Dong Qian
Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China.
Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China.
World J Gastrointest Surg. 2024 Apr 27;16(4):1066-1077. doi: 10.4240/wjgs.v16.i4.1066.
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.
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.
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.
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.
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.
即使经过全程新辅助化疗（NAC），若肝母细胞瘤（HB）仍与主要肝血管（PMV）紧密相邻，其治疗将变得具有挑战性。在这种情况下，极限肝切除术可被视为一种潜在选择。
探讨计算机辅助三维个体化极限肝切除术对于经过全程NAC后仍存在PMV的HB患儿是否安全可行。
我们回顾性收集了2013年6月至2023年6月在本中心接受手术切除的HB患儿的数据。然后分析了经过全程NAC后仍存在PMV的HB患儿的详细临床和三维特征。
67例诊断为HB的患儿接受了手术切除。诊断时的年龄为21.4±18.8个月，包括40例男孩和27例女孩。59例（88.1%）患者为单发肿瘤，其中39例（58.2%）位于肝右叶。共有47例患者（70.1%）处于PRE-TEXT III或IV期。39例患者（58.2%）接受了延迟切除。经过全程NAC后，16例患者仍有紧密的PMV（2例距离在1cm以内，11例相邻，4例受压，3例有肿瘤血栓）。有6例患者的肿瘤位于肝中叶，其中4例表现出肝脏解剖变异。这16例患儿在经过全面的术前评估后接受了极限肝切除术。术中操作按照术前计划进行，手术均成功完成。目前，67例HB患儿的3年无事件生存率为88%。在接受极限肝切除术的16例患儿中，3例出现复发，1例因多发转移死亡。
对于经过全程NAC后仍与PMV紧密相邻的HB，极限肝切除术既安全又可行。这种方法不仅减少了肝移植的必要性，而且预后良好。个体化的三维手术规划有利于准确、完整地切除HB，特别是在评估血管受累情况、残余肝体积和解剖变异方面。
