Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2024; 16(4): 1066-1077
Published online Apr 27, 2024. doi: 10.4240/wjgs.v16.i4.1066
Computer-assisted three-dimensional individualized extreme liver resection for hepatoblastoma in proximity to the major liver vasculature
Wen-Li Xiu, Jie Liu, Jing-Li Zhang, Jing-Miao Wang, Xue-Feng Wang, Fei-Fei Wang, Jie Mi, Xi-Wei Hao, Nan Xia, Qian Dong
Wen-Li Xiu, Jing-Li Zhang, Jing-Miao Wang, Xue-Feng Wang, Jie Mi, Xi-Wei Hao, Qian Dong, Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Jie Liu, Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
Fei-Fei Wang, Nan Xia, Qian Dong, Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Shandong College Collaborative Innovation Center of Digital Medicine Clinical Treatment and Nutrition Health, Qingdao University, Qingdao 266003, Shandong Province, China
Co-first authors: Wen-Li Xiu and Jie Liu.
Co-corresponding authors: Nan Xia and Qian Dong.
Author contributions: Xiu WL, Liu J, and Zhang JL contributed to data curation and writing of the original draft; Wang JM, Wang XF, and Wang FF contributed to data curation; Mi J, Hao XW, Xia N, and Dong Q contributed to manuscript review and editing; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82293665; and Anhui Provincial Department of Education University Research Project, No. 2023AH051763.
Institutional review board statement: This study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University (approval No. QYFY-WZLL-25776).
Informed consent statement: This is a retrospective study article, and all guardians of the patients signed the informed consent forms before treatment and surgery. The patient's identity information was not disclosed and will not cause any harm to the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qian Dong, MD, Professor, Surgeon, Teacher, Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266000, Shandong Province, China. 18661801885@163.com
Received: November 21, 2023
Peer-review started: November 21, 2023
First decision: January 19, 2024
Revised: January 29, 2024
Accepted: March 15, 2024
Article in press: March 15, 2024
Published online: April 27, 2024
Processing time: 152 Days and 21.6 Hours
Abstract
BACKGROUND

The management of hepatoblastoma (HB) becomes challenging when the tumor remains in close proximity to the major liver vasculature (PMV) even after a full course of neoadjuvant chemotherapy (NAC). In such cases, extreme liver resection can be considered a potential option.

AIM

To explore whether computer-assisted three-dimensional individualized extreme liver resection is safe and feasible for children with HB who still have PMV after a full course of NAC.

METHODS

We retrospectively collected data from children with HB who underwent surgical resection at our center from June 2013 to June 2023. We then analyzed the detailed clinical and three-dimensional characteristics of children with HB who still had PMV after a full course of NAC.

RESULTS

Sixty-seven children diagnosed with HB underwent surgical resection. The age at diagnosis was 21.4 ± 18.8 months, and 40 boys and 27 girls were included. Fifty-nine (88.1%) patients had a single tumor, 39 (58.2%) of which was located in the right lobe of the liver. A total of 47 patients (70.1%) had PRE-TEXT III or IV. Thirty-nine patients (58.2%) underwent delayed resection. After a full course of NAC, 16 patients still had close PMV (within 1 cm in two patients, touching in 11 patients, compressing in four patients, and showing tumor thrombus in three patients). There were 6 patients of tumors in the middle lobe of the liver, and four of those patients exhibited liver anatomy variations. These 16 children underwent extreme liver resection after comprehensive preoperative evaluation. Intraoperative procedures were performed according to the preoperative plan, and the operations were successfully performed. Currently, the 3-year event-free survival of 67 children with HB is 88%. Among the 16 children who underwent extreme liver resection, three experienced recurrence, and one died due to multiple metastases.

CONCLUSION

Extreme liver resection for HB that is still in close PMV after a full course of NAC is both safe and feasible. This approach not only reduces the necessity for liver transplantation but also results in a favorable prognosis. Individualized three-dimensional surgical planning is beneficial for accurate and complete resection of HB, particularly for assessing vascular involvement, remnant liver volume and anatomical variations.

Keywords: Children; Hepatoblastoma; Surgery; Three-dimensional; Computer-assisted

Core Tip: Children with difficult hepatoblastoma (HB), characterized by a large size and complex location, pose a clinical challenge, particularly when the tumor remains in close proximity to the major liver vasculature (PMV) even after a full course of neoadjuvant chemotherapy (NAC). We retrospectively collected data from 67 children with HB who underwent surgical resection at our center from June 2013 to June 2023. Sixteen patients still had close PMV after a full course NAC and underwent extreme liver resection. In this process, the use of individualized three-dimensional surgical planning is beneficial for achieving safe and complete resection.