title: Impact of postoperative complications on overall survival of patients with hepatoblastoma.
abstract: BACKGROUND
  Complete resection of hepatoblastoma (HB) is a demanding procedure in advanced tumors. Perioperative complications are still common. The influence of complication rates on course of disease and survival of patients with HB has not been analyzed yet.
  
  
  METHODS
  Patients with high risk (HR) HB and standard-risk (SR) HB registered from 1999 to 2008 to the German prospective multicenter study HB99 were evaluated regarding perioperative complications, reasons (e.g., tumor size and vessel involvement) and impact on further treatment and overall survival (OS).
  
  
  RESULTS
  Surgical data from 126 patients were available (47 HR-HB, 79 SR-HB). Postoperative complications occurred in 26 (21%) patients consisting of biliary leakage (n = 9), cholestasis (n = 5), deficit of liver perfusion (n = 5) and others (n = 7). Twenty of these 26 patients (77%) required a second operation. The rate of postoperative complications was higher in the HR-group (26%) compared to the SR-group (17%). Patients with vessel involvement had significantly more complications (17% vs. 54%, P = 0.01). Patients with PRETEXT I/II-tumors had the same rate of postoperative complications (19% vs. 20%) as patients with PRETEXT III/IV. Patients of HR-group with postoperative complications showed delayed start in adjuvant chemotherapy (>21 d) (75% vs. 25%, n.s.) combined with significant lower 5-year-OS (75% vs. 50%, P = 0.02). In multivariate analysis postoperative complications were an independent negative prognostic factor for HR-patients (HR 3.1, P = 0.04).
  
  
  CONCLUSIONS
  Postoperative complications after HB resection are frequent and associated with worsened OS of patients with HR-HB. One possible reason is delay in postoperative chemotherapy. The approach to precarious liver resection should be carefully planned and executed by specialists.
authors.affiliation: Department of Pediatric Surgery, Ludwig-Maximilian-University of Munich, Munich, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Becker
authors.forename: Christiane
authors.initials: C
authors.lastname: Furch
authors.forename: Irene
authors.initials: I
authors.lastname: Schmid
authors.forename: Dietrich
authors.initials: D
authors.lastname: von Schweinitz
authors.forename: Beate
authors.initials: B
authors.lastname: Häberle
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D018197:Hepatoblastoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
keywords: hepatoblastoma (HB); high-risk (HR) group; postoperative complications; tumor resection; vessel involvement