Observational Study
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World J Gastroenterol. Aug 7, 2014; 20(29): 10137-10143
Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.10137
Efficacy of neoadjuvant therapy and surgical rescue for locally advanced hepatoblastomas: 10 year single-center experience and literature review
Dolores Ayllon Teran, Oscar Gómez Beltran, Rubén Ciria Bru, Elena Mateos González, María José Peña Rosa, Antonio Luque Molina, Pedro López Cillero, Javier Briceño Delgado
Dolores Ayllon Teran, Rubén Ciria Bru, Antonio Luque Molina, Pedro López Cillero, Javier Briceño Delgado, Department of Surgery, Reina Sofia Hospital, 14005 Córdoba, Spain
Oscar Gómez Beltran, Department of Pediatric Surgery, Reina Sofia Hospital, 14005 Córdoba, Spain
Elena Mateos González, María José Peña Rosa, Department of Pediatric Oncology, Reina Sofia Hospital, 14005 Córdoba, Spain
Author contributions: Ayllon Teran D, Gómez Beltran O and Ciria Bru R designed the study, took part in data acquisition and writing the paper; Mateos González E, Peña Rosa MJ, Luque Molina A and Briceño Delgado J analyzed the data and revised the article critically for important intellectual content; López Cillero P and Briceño Delgado J approved the final version of the paper to be published.
Correspondence to: Dr. Dolores Ayllon Teran, Department of Surgery, Reina Sofia Hospital, Avda, Menéndez Pidal s/n, 14005 Córdoba, Spain. lolesat83@hotmail.com
Telephone: +34-95-7010439 Fax: +34-95-7012876
Received: August 16, 2013
Revised: October 18, 2013
Accepted: December 5, 2013
Published online: August 7, 2014
Processing time: 356 Days and 9.4 Hours
Abstract

AIM: To report our experience with long-term outcomes after multimodal management therapy.

METHODS: An observational retrospective study was performed containing seven patients with hepatoblastoma (Hbl) treated in our institution, a tertiary referral center, from 2003 to 2011. Demographic, preoperative, surgical, and outcome variables were collected. A survival analysis and a review of the current literature related to combination neoadjuvant chemotherapy and surgical resection on Hbl were performed.

RESULTS: The median age at surgery was 14.4 mo, with a male to female ratio of 4:3. Pretext staging at diagnosis was as follows: stage I, 4 cases; stage II, 2 patients; and stage III, 1 case. Mean pretreatment tumor volume was 735 cm3. Five out of seven patients received neoadjuvant chemotherapy according to SIOPEL-3 or SIOPEL-6 protocols. Tumor volume and alpha-fetoprotein levels significantly dropped after neoadjuvant therapy. Surgical procedures performed included hemihepatectomies, segmentectomies and atypical resection. All patients received chemotherapy after surgery. Median postoperative hospital stay was 8 d. All patients were alive and disease-free after a median follow-up period of 23 mo. With regards to the literature review, seventeen articles were found that were related to our search.

CONCLUSION: Our series shows how multimodal management of Hbl, exhaustive control and a meticulous surgical approach leads to almost 100% complete resection with optimal postoperative results.

Keywords: Liver tumors; Chemotherapy; Liver surgery; Multimodal management

Core tip: Complete surgical resection is the cornerstone of treatment for hepatoblastoma (Hbl), but less than 40% of patients have resectable disease at diagnosis. Our experience with long-term outcomes after multimodal management therapy and a review of the literature are reported. An observational retrospective study was performed, including seven patients with Hbl treated in our institution, a tertiary referral center, from 2003 to 2011. Our series shows how multimodal management of Hbl, exhaustive control and a meticulous surgical approach leads to almost 100% complete resection with optimal postoperative results.