title: Successful nontransplant resection of POST-TEXT III and IV hepatoblastoma.
abstract: BACKGROUND
  Liver transplantation is increasingly advocated as primary surgical therapy for children with hepatoblastoma involving 3 or 4 sectors of the liver after neoadjuvant chemotherapy. This study evaluated the results of nontransplant hepatectomy in children who might otherwise have been considered for liver transplantation.
  
  
  METHODS
  All children who underwent resection at a single institution from 1998 to 2009 for POST-TEXT IV or centrally located POST-TEXT III hepatoblastoma after neoadjuvant chemotherapy were reviewed.
  
  
  RESULTS
  Fourteen children (7 boys) with a median age of 8 months at diagnosis met study criteria. Pulmonary metastases in 3 patients were resected in 2 and resolved with chemotherapy in 1 patient. Preoperative grouping after neoadjuvant chemotherapy was POST-TEXT IV in 3 patients and POST-TEXT III in 11 patients. Thirteen of 14 (93%) children who underwent aggressive resection despite being potential candidates for primary transplantation were alive and tumor-free with a median follow-up of 57 months. Observed survival rates at 1, 2, and 5 years were 93%, 91%, and 88% respectively. Event-free survival rates at 1, 2, and 5 years were 93%, 91%, and 75%, respectively.
  
  
  CONCLUSIONS
  Excellent survival (93%) was obtained with aggressive resection in children with POST-TEXT III and IV hepatoblastoma meeting criteria for transplant referral. The 1 death occurred in a patient with unfavorable small cell histology. These children should be managed at institutions experienced in both advanced pediatric hepatobiliary surgery and transplantation. Operative exploration was frequently required to ultimately determine which tumors can be resected and which require transplantation.
authors.affiliation: Department of Surgery, Children's Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois 60614, USA.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Lautz
authors.forename: Tamar
authors.initials: T
authors.lastname: Ben-Ami
authors.forename: Niramol
authors.initials: N
authors.lastname: Tantemsapya
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Gosiengfiao
authors.forename: Riccardo A
authors.initials: RA
authors.lastname: Superina
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D018197:Hepatoblastoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D020360:Neoadjuvant Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents