Feasibility of Real-Time Central Surgical Review for Patients with Advanced-Stage Hepatoblastoma in the JPLT3 Trial

Abstract

In the JPLT3 study, a real-time central surgical reviewing (CSR) system was employed aimed at facilitating early referral of candidates for liver transplantation (LTx) to centers with pediatric LTx services. The expected consequence was surgery, including LTx, conducted at the appropriate time in all cases. This study aimed to review the effect of CSR on institutional surgical decisions in cases enrolled in the JPLT3 study. Real-time CSR was performed in cases in which complex surgeries were expected, using images obtained after two courses of preoperative chemotherapy. Using the cloud-based remote image viewing system, an expert panel consisting of pediatric and transplant surgeons reviewed the images and commented on the expected surgical strategy or the necessity of transferring the patient to a transplant unit. The results were summarized and reported to the treating institutions. A total of 41 reviews were conducted for 35 patients, and 16 cases were evaluated as possible candidates for LTx, with the treating institutions being advised to consult a transplant center. Most of the reviewed cases promptly underwent definitive liver surgeries, including LTx per protocol.

Application of 3D Simulation Software in Chemotherapy and Hepatoblastoma Surgery in Children

“…HB is the most common malignant liver tumor in children, but most cases cannot be operated on in one stage because of its large volume and proximity to the surrounding blood vessels ( 18 – 20 ). Neoadjuvant chemotherapy can significantly reduce the tumor volume so that most tumors can be completely removed and a good prognosis can be obtained ( 21 – 23 ). Studies have confirmed that HB can be evaluated to determine whether the tumor can be completely removed by surgery after two cycles of chemotherapy, and the judgment of its resectability mainly depends on the location and volume of the tumor after chemotherapy, the relationship with the surrounding important blood vessels, and the evaluation of the residual functional liver volume ( 9 , 12 , 14 ).…”