Resection for primary liver tumors in children: an experience of 52 cases at one institution.
OBJECTIVE
To review the authors' experiences of liver resection for primary tumors in children.


METHODS
The children who had undergone liver resection for any masses between January 1996 and December 2005 were studied. Their clinical data and pathological reports were reviewed for descriptive study. Surgical data including the extent of lesions, type of resection, and post-operative complications within 60 days after surgery were analyzed. Data are expressed as mean and standard deviation (SD).


RESULTS
Fifty-two children, with a male to female sex ratio of 28:24, underwent resection for primary liver tumors. Their average age was 36.64 +/- 4.05 months and average weight was 12.02 +/- 6.76 Kg. Asymptomatic mass was the main complaint. Ultrasonography was the initial investigation and CT scan was performed later in all patients with suspected liver mass to confirm the diagnosis and to assess the resectability. CT scan was also useful for the diagnosis of liver tumor in six cases which ultrasonography could not differentiate from other abdominal tumors. The tumors were assessed to be unresectable in 28 of 52 (53.8%) patients who had preoperative chemotherapy and became resectable later. Surgical procedures were as follows: 39 hepatic lobectomies, six extended hepatic lobectomies, and seven segmentectomies. Mean operative time was 251.04 +/- 89.22 min. Mean ICU stay was 2.8 +/- 3.2 days. Pathology revealed 38 hepatoblastomas, five hemangioendotheliomas, four hepatomas, two harmatomas, and three other lesions. Post-operative complications occurred in 15 children (29%) including intra-abdominal bleeding (3), subphrenic collection (1), acute liver failure (3), wound infection (2), and atelectasis (6). No mortality within 60 days after surgery occurred. Most of the patients were discharged within 10 days after surgery.


CONCLUSIONS
With the advancement of preoperative evaluation, more accurate diagnosis of liver tumors, and the extent of lesions has led to the proper more effective surgical resection and further treatment, then led to zero mortality rate related to liver resection for primary tumors in the present series. Although there were significant complications, mostly minor problems and all both minor and major complications were manageable; their fatal potentials should not be underestimated.
Chittmittrapap
Soottiporn
S
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Imvised
Tawan
T
Vejchapipat
Paisarn
P
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography