Outcome of Liver Resection for Hepatoblastoma in Children from a General Pediatric Surgery Referral Center

A BSTRACT Background: Hepatoblastoma (HB) is the most common malignant liver tumor in children under 3 years of age. Surgical resection, combined with neoadjuvant chemotherapy, is essential for optimal outcomes. We present a 10-year institutional experience focusing on technical tips for liver resection in children with HB. Materials and Methods: A retrospective review of pediatric HB patients who underwent liver resection at a tertiary care Children’s hospital from January 2014 to June 2024 was conducted. All patients received preoperative PLADO (cisplatin + doxorubicin) chemotherapy per SIOPEL guidelines. Surgical resection type, outcomes, recurrence, and survival data were analyzed. Technical considerations for standard and complex hepatectomies were described. Results: Out of 26 children with HB (mean age 15 months), 19 (73%) underwent liver resection. Right hepatectomy was the most common (42%), followed by left hepatectomy and segmentectomies. No patient developed postoperative liver failure. Two patients (10.5%) experienced recurrence; one was salvaged successfully. The disease-free survival rate was 89.5%, and overall survival at 3 and 5 years was 81.8%. Surgical margins were negative in all patients. Technical tips adopted to improve visualization, minimize blood loss, avoid bile duct injury, and vascular inflow and outflow control are detailed. Conclusion: Liver resection with adjuvant chemotherapy (PLADO and SIOPEL) results in favorable outcome in children with HB. Understanding the anatomical nuances and meticulous surgical technique improves outcomes and minimizes complications.