Yao Wei,Dong Kuiran,Li Kai,et al.Efficacies of extended hepatic resection for POST-TEXT Ⅲ/Ⅳ hepatoblastoma[J].Journal of Clinical Pediatric Surgery,,19():386-391.[doi:10.3969/j.issn.1671-6353.2020.05.003]
Efficacies of extended hepatic resection for POST-TEXT Ⅲ/Ⅳ hepatoblastoma
- CLC:
- R726.1;R735.7
- Abstract:
- Objective To explore the long-term therapeutic outcomes of hepatectomy for POST-TEXT (post-treatment extent of disease) Ⅲ/Ⅳ hepatoblastoma.Methods From January 2009 to June 2019,clinical data were analyzed retrospectively for 37 children of POST-TEXT Ⅲ/Ⅳ hepatoblastoma,including PRETEXT stage,alpha-fetoprotein (AFP),computed tomography (CT) or magnetic imaging imaging (MRI) findings,tumor resection mode and prognostic results.The survival rate was analyzed by Kaplan Meier method of SPSS18.0.Results There were 25 boys and 12 girls with an average age of (23.92±22.45) months.The stages of POST-TEXT were Ⅲ(n=34) and Ⅴ(n=3).One case of PRETEXT Ⅱ was upgraded to POST-TEXT Ⅳ while another three cases of PRETEXT Ⅳ were downgraded to POST-TEXT Ⅲ.Neoadjuvant chemotherapy was performed in 8 cases (21.6%),22 (59.4%) and 7 (18.9%) for 2,4 and 6 cycles respectively.Except for liver transplantation and abandonment of treatment (n=2),the remainders underwent hepatic trisectionectomy (n=7),extended hemihepatectomy (n=8),irregular hepatectomy (n=4),mesohepatectomy (n=12) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS,n=4).The average operative duration was (262.29±107.16) min and the average bleeding volume (236.86±212.41) ml.The technique of Glisson’s pedicle approach was employed for 22 cases.The average volume of bleeding was (147.73±137.46) ml and the incidence of bile leakage 27.3%.Compared with cases without the technique,the incidence of bleeding was significantly lower (P=0.001) while the incidence of bile leakage was similar (23.1%,P=0.784).Seven cases (20.0%) had a resection margin >1 cm,15 cases (42.9%) a margin of 0.5-1 cm,7 cases (18.9%) a margin <0.5 cm and 6 cases (16.2%) a margin close-to-tumor.The average recurrence time was (6±3.96) months.No significant difference existed between tumor recurrence or operation mode and distance of tumor margin(P>0.05).The overall 5-year survival rate was 72.3% and the 5-year event-free survival rate 67.4%.According to the classification of margin distance,the 5-year overall survival rates of tumor margin >1 cm,0.5-1 cm,<0.5 cm and close-to-tumor were 85.7%,78.0%,83.3% and 53.3% respectively.No significant difference existed among the groups (P=0.701).Conclusion For POST-TEXT Ⅲ/Ⅳ hepatoblastoma,appropriate operations with optimal therapeutic outcomes may be selected according to different parts of tumor involvement.Mastering the technique of Glisson reduces the occurrences of bleeding and bile duct injury.And maintaining a certain margin distance intraoperatively can lower the recurrence of tumor and further improve the survival rate.
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Memo
收稿日期:2020-03-08。
基金项目:国家自然科学基金面上项目（编号：81572324）
通讯作者:董岿然,Email:kuirand@hotmail.com