Outcome of central hepatectomy for hepatoblastomas.
OBJECTIVE
Central hepatoblastomas (CHBL) involving liver segments (IV + V) or (IV + V + VIII) are in contact with the portal bifurcation. Their resection may be achieved by central hepatectomy (CH) with thin resection margins on both sides of the liver pedicle, by extended right or left hepatectomy with thin resection margins on one side, or by liver transplantation with thick free margins. The aim of this study is to assess the operative and postoperative outcome of CH for hepatoblastoma.


METHODS
This was a retrospective monocentric study of 9 patients who underwent CH for CHBL between 1996 and 2008.


RESULTS
The operative time was 4 hours 50 minutes (2 hours 20 minutes to 7 hours), vascular clamping lasted 30 minutes (0-90 minutes), and the amount of blood cell transfusion was 250 mL (0-1800 mL). Two patients had biliary leakage requiring percutaneous drainage. Median follow-up time was 27 months (14-120 months). All of 8 nonmetastatic patients are alive and disease-free; 1 metastatic patient died of recurrent metastases at last follow-up. Although 3 of 9 patients had surgical margins less than 1 mm, none, including the patients who died from metastases, had local recurrence.


CONCLUSIONS
Our study demonstrates the feasibility of CH for CHBL without operative mortality or local recurrence. Central hepatectomy is an alternative to extensive liver resections in selected patients.
Guérin
Florent
F
Department of Pediatric Surgery, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, University Paris XI., Le Kremlin-Bicêtre, France. florent.guerin-chir@bct.aphp.fr
Gauthier
Frédéric
F
Martelli
Hélène
H
Fabre
Monique
M
Baujard
Catherine
C
Franchi
Stéphanie
S
Branchereau
Sophie
S
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D018197:Hepatoblastoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome