The surgical management of children with incompletely resected hepatic cancer is facilitated by intensive chemotherapy

King, Denis R.; Ortega, Jorge A.; Campbell, John R.; Haas, Joel E.; Ablin, Arthur R.; Lloyd, David; Newman, Kurt D.; Quinn, John F.; Krailo, Mark; Feusner, James; Hammond, Denman

doi:10.1016/0022-3468(91)90677-l

Cited by 80 publications

(50 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…More recently, continuous-infusion Adriamycin and cisplatin facilitated delayed hepatic resection in 20 of 34 (59%) initially unresectable liver tumors. 1 In the present series preoperative chemotherapy facilitated removal of 8 of 15 HEP but only 2 of 17 HCC tumors (one with positive margins) by delayed resection.…”

Section: Discussionmentioning

confidence: 55%

“…14 However, this has not been a universal finding, and in the CCSG/POG experience, survival following delayed resection and primary resection was 41% and 58%, respectively. 1 This apparent improvement in survival by delayed resection has been accompanied by a definite increase in operative morbidity. In our series, EBL for primary versus delayed HEP resection of was 143 mL versus 1,100 mL (P < .05).…”

Section: Discussionmentioning

confidence: 99%

“…The recent CCSG/POG intergroup prospective study reported similar findings, with morbidity rates of 8% and 25% for primary and delayed resection. 1 Partial hepatectomy, either primary or delayed, was considered first for all patients in this series. Twenty patients were initially evaluated elsewhere, felt to be unresectable, and were then referred for OLT.…”

Section: Discussionmentioning

confidence: 99%

“…All but 5 of the 42 patients presented with an abdominal mass. Associated diseases were common, especially in HCC: tyrosinemia (4), hepatitis B (2), complex congenital heart disease (2), and neonatal hepatitis (1). Two patients with HEP had the Beckwith-Wiedemann syndrome.…”

Section: Demographicsmentioning

confidence: 99%

“…Thirteen children underwent total hepatectomy and OLT and 2 children underwent the cluster procedure. Three children were returned to the operating room within 48 hours of their transplant for bleeding (2) or suspected intestinal perforation (1). Eleven children experienced acute rejection episodes requiring immunosupressive changes and one child required retransplant for chronic rejection.…”

Section: Transplantationmentioning

confidence: 99%

See 4 more Smart Citations

Resection, including transplantation, for hepatoblastoma and hepatocellular carcinoma: Impact on survival

Tagge

Reyes

et al. 1992

Journal of Pediatric Surgery

118

View full text Add to dashboard Cite

Long-term survival in children with primary hepatic malignancies can not be expected without complete tumor resection. In the last ten years we have treated 21 children with hepatocellular carcinoma (HCC) and 21 children with hepatoblastoma (HEP), with tumor extirpation our surgical goal. Operative treatment included partial hepatectomy ([PH] 20), either primary (10) or delayed (following chemotherapy) (10), total hepatectomy and orthotopic liver transplantation ([OLT] 13), or upper abdominal exenteration and multiple organ transplantation (2). Two patients had both PH and subsequent total hepatectomy and OLT. Overall survival was 48% (20/42), with 9 patients dying of progressive disease prior to removal of their tumor. HEP patient survival was 67% (14/21), including 2 of 6 who underwent primary PH, 7 of 8 who had delayed PH, and 5 of 6 who underwent OLT. Survival for the children with HCC was 29% (6/21), including 1 of 4 after primary PH, 1 of 2 following delayed PH, 3 of 7 following OLT, and 1 of 2 after exenteration and multiple organ transplantation. Preoperative chemotherapy facilitated removal of 10 initially unresectable tumors (8 HEP, 2 HCC) at a second-look procedure. Total hepatectomy and OLT markedly improved survival in patients with disease unresectable by standard methods. Partial hepatectomy, either primary or delayed, should be attempted in all children with hepatic malignancies. Total hepatectomy and OLT appears to be a viable adjunct in the treatment of childhood malignancies, and should be used for otherwise unresectable tumors as part of a carefully planned protocol. INDEX WORDSHepatoblastoma; hepatocellular carcinoma; liver transplantation Childhood liver tumors continue to have a poor prognosis despite increasingly sophisticated diagnostic methods, aggressive surgical techniques to achieve complete resection, and more effective systemic chemotherapy. Total surgical removal remains the mainstay of treatment, although there are rare reports of long-term survivors achieved with chemotherapy alone. Preoperative chemotherapy has increased the number of patients undergoing potentially curable resections. 1 However, a large proportion of children, especially with hepatocellular carcinoma (HCC), are not resectable by standard methods. Total hepatectomy and orthotopic liver transplantation (OLT), the only alternative for unresectable tumors, is still controversial due to the high incidence of tumor recurrence. 2Address reprint requests to Edward P. Tagge, MD,

show abstract

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Demographicsmentioning

confidence: 99%

Section: Transplantationmentioning

confidence: 99%

See 3 more Smart Citations