Role of Mesohepatectomy for Pediatric Centrally Located Liver Tumors

Abstract

Background: Mesohepatectomy (MH) or central hepatectomy (CH) is a recognized surgical technique for centrally located pediatric liver tumors. This technique of liver resection avoids extended liver resections and thereby helps in the preservation of liver parenchyma. In this article, we aim to analyze our experience and outcome with this technique of liver resection.

Methods: A retrospective analysis of patients who underwent MH from January 2015 to June 2023 at our institute was performed. The variables analyzed include demographics, preoperative treatment, perioperative management, and postoperative outcome.

Results: A total of five patients underwent CH. Four patients had hepatoblastoma, and one patient had mesenchymal hamartoma. All four patients with hepatoblastoma received neoadjuvant chemotherapy. All five patients had negative surgical margins, and one of the five developed disease recurrences necessitating resurgery and ultimately died of metastasis. one patient sustained intraoperative major bile duct injuries, and one patient had postoperative Abnormal, well-circumscribed, extra-biliary collection of bile.

Conclusion: MH with clear margins is feasible in the selected subset of pediatric liver tumors involving segments IV, V, and VIII with outcomes equivalent to extended hepatic resections.

Keywords: Central hepatic resection; mesohepatectomy; pediatric hepatic tumors.

Figure 1

(a) POSTTEXT Stage III (Type D) tumors, (b) Contrast-enhanced computed tomography image of tumor in Segments IV and V

Figure 2

(a-d) Steps of mesohepatectomy procedure