Two-stage laparoscopic resection of giant hepatoblastoma in infants combined with liver partial partition and artery ligation

Abstract

Purpose: Laparoscopic resection of giant hepatoblastoma (HB) in children has long been a subject of controversy. Here, a new procedure of two-stage laparoscopic resection of giant HB in infants was firstly reported and the feasibility was discussed.

Methods: The clinical data of three infants with HB were retrospectively reviewed, all of which received 3-5 cycles of neoadjuvant chemotherapy. Stage 1 laparoscopic selective hepatic artery ligation and liver partial partition were performed. Stage 2 laparoscopic hepatectomy was performed 2 weeks later.

Results: The results demonstrated that (1) the tumors shrank considerably in size and had relatively clear boundaries after neoadjuvant chemotherapy; (2) after stage 1 surgery, the tumor volume further reduced, while the intratumoral necrosis expanded; (3) 2 weeks later, stage 2 laparoscopic hepatectomy was performed successfully; (4) none of the cases had intraoperative complications such as tumor rupture, air embolism, hemorrhage, biliary fistula, or liver failure, and there was no recurrence or metastasis during follow-up.

Conclusions: Two-stage laparoscopic hepatectomy associating selective hepatic artery ligation and liver partial partition for HB in infants has the benefits of small invasiveness, fast recovery, improved safety, and high feasibility. However, more cases and longer follow-up are needed to assess its long-term efficacy.

Keywords: Hepatoblastoma; Infant; Laparoscopy; Staged surgery.

Fig. 1

a The artery which supplies blood to the tumor (right branch of hepatic artery) was ligated with Hem-O-lok clips under the laparoscope. b Liver parenchyma was partially divided with an ultrasonic scalpel, with the dividing depth of about 2.5 cm

Fig. 2

a Upon the first visit, CTA revealed giant tumor in the right lobe of liver with unclear boundary, involvement of the right branch of portal vein and tumor thrombi. There were local involvement of the hepatic segment of inferior vena cava and right hepatic vein. There was tumor thrombus in the central vein of liver. b The Hisense CAS system reconstructs tumors, liver, and blood vessels. At the time of initial diagnosis, the tumor volume reached 1034.5 ml. c The Hisense CAS system simulates hepatectomy, and the residual liver volume percentage is only 18.32%, which cannot meet the needs of liver resection. d After neoadjuvant chemotherapy, the tumor volume shrank considerably than before. e The Hisense CAS system reconstituted tumors, liver, and blood vessels, and the residual liver volume was increased. f CTA revealed that the right branch of hepatic artery supplied blood to the tumor. g At 2 weeks after stage 1 laparoscopic right hepatic artery ligation and partial partition of liver parenchyma, the tumor further shrank in size and the intratumoral necrosis further expanded. h After reconstruction of the tumor, liver, and blood vessels by the Hisense CAS system, the tumor volume further shrank and the residual liver volume was further increased. The blood flow to the tumor from the right hepatic artery was cut off by the ligation. i Postoperative CTA located the partition line in liver parenchyma

Fig. 3

a There was no tumor residue or recurrent at 24 months after surgery. b The compensatory hypertrophy of the left liver lobe was significant at 24 months after surgery