Surgical perspectives of primary liver tumors in children: A series of 76 consecutive cases

Abstract

Background: Primary liver tumors in children are rare. The objective of this study was to review cases of primary liver tumors in children who underwent tumor removal.

Methods: Children (0 - 15 years old) who underwent surgery for primary liver tumors between 2006 and 2019 were studied. Their clinical data and pathological reports were reviewed. Demographic data, types of procedures, operative time, and post-operative complications were described. Data are expressed as mean standard deviation.

Results: There were 76 children (male/female = 39/37), who underwent resection for primary liver tumors. Their average age was 27.9 32.0 months. Asymptomatic abdominal mass was the most common findings. Ultrasonography, computerized tomography (CT) scan or magnetic resonance imaging (MRI) was used to confirm diagnosis and plan for the surgery. The tumors were assessed to be initially unresectable in 57/79 patients (72.2%), and became resectable later following chemotherapy. Types of surgery included 51 hepatectomies (67.1%), 9 trisectionectomies (11.8%), 7 multiple segmentectomies (9.2%), 6 segmentectomies (7.9%), and 3 wedge resections (4.0%). The mean operative time, blood loss, and Intensive Care Unit stay were 204.14 82.08 minutes, 274.1 440.4 ml, and 2.1 3.1 days, respectively. Histopathology revealed 63 hepatoblastomas (82.9%), 4 mesenchymal hamartomas and one of endodermal sinus tumor, mature teratoma, immature teratoma, adenoma, hepatoma, undifferentiated embryonal sarcoma, focal nodular hyperplasia, glomus tumor, and undetermined benign liver tumor. The most common intra-operative complication was massive bleeding in 8 cases, with cardiac arrest in one case. Post-operative complication was found in 16 cases (21.1%) including chylous ascites, atelectasis, intra-abdominal collection, surgical site collection, C-line infection, ileus, gut obstruction, bleeding and bile leakage. Re-operation was required to correct complications in 3 patients. There was one mortality caused by spontaneous rupture of congenital hepatoblastoma.

Conclusions: The most common primary liver tumor in children that requires surgical therapy is hepatoblastoma. Abdominal mass is a common symptom. Serious complications occurred in 20.0% of patients with a small chance of re-operation. Peri-operative mortality is low.