Eur J Pediatr Surg 2021; 31(03): 236-244
DOI: 10.1055/s-0040-1710328
Original Article

Feasibility of Nonanatomical Liver Resection in Diligently Selected Patients with Hepatoblastoma and Comparison of Outcomes with Anatomic Resection

1   Division of Paediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer, Tata Memorial Centre, Mumbai, India
2   Homi Bhabha National Institute, Mumbai, India
,
Seema A. Kembhavi
2   Homi Bhabha National Institute, Mumbai, India
3   Department of Radiology, Tata Memorial Hospital, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer, Tata Memorial Centre, Mumbai, India
,
4   Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Vasundhara Smriti
2   Homi Bhabha National Institute, Mumbai, India
3   Department of Radiology, Tata Memorial Hospital, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer, Tata Memorial Centre, Mumbai, India
,
Akshay Baheti
2   Homi Bhabha National Institute, Mumbai, India
3   Department of Radiology, Tata Memorial Hospital, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer, Tata Memorial Centre, Mumbai, India
,
Tushar Vora
2   Homi Bhabha National Institute, Mumbai, India
,
Girish Chinnaswamy
2   Homi Bhabha National Institute, Mumbai, India
5   Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer, Tata Memorial Centre, Mumbai, India
,
Maya Prasad
2   Homi Bhabha National Institute, Mumbai, India
5   Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Training Research and Education in Cancer, Tata Memorial Centre, Mumbai, India
,
Nayana Amin
2   Homi Bhabha National Institute, Mumbai, India
6   Department of Anesthesia, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Mukta Ramadwar
2   Homi Bhabha National Institute, Mumbai, India
7   Department of Pathology, Tata Memorial Hospital, Bombay, Maharashtra, India
,
Nehal Khanna
2   Homi Bhabha National Institute, Mumbai, India
8   Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Sidharth Laskar
2   Homi Bhabha National Institute, Mumbai, India
8   Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
› Institutsangaben

Abstract

Introduction Treatment guidelines for hepatoblastoma discourage nonanatomic liver resections. However, the evidence for this is inadequate and comes from a study performed almost two decades ago which additionally contained inherent limitations. This study aimed to assess the feasibility and oncologic outcomes of nonanatomic resections (NAR) performed in diligently selected patients and compare the results with anatomic resections (AR).

Materials and Methods A total of 120 patients who underwent liver resections for hepatoblastoma between January 2008 and July 2019 were reviewed. Feasibility of NAR was based on postchemotherapy relations to vessels, site of the lesion, and possibility of achieving negative resection margins.

Results AR was performed in 95 patients and 25 had NAR. The NAR cohort had similar International Childhood Liver Tumors Strategy Group (SIOPEL) risk group distribution. Blood loss and operative times were lower in patients undergoing NAR. No differences were noted between the two groups concerning postoperative morbidity and hospitalization. There were no pathologic positive margins or local recurrences in the NAR patients. Relapse free (RFS) and overall survival (OS) was similar in the two groups (p = 0.54 and 0.96, respectively). Subgroup analysis of only posttreatment extent of tumor (POSTTEXT) I and II patients also showed no difference in RFS or OS for the two groups with a persistent significant difference in operative times and blood loss.

Conclusion NAR is feasible with clear margins in carefully selected patients. It is not associated with more complications and outcomes are not inferior to AR. NAR is associated with lesser blood loss and operative time.



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Eingereicht: 05. Februar 2020

Angenommen: 05. April 2020

Artikel online veröffentlicht:
18. Mai 2020

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