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Eur J Pediatr Surg 2021; 31(05): 432-438
DOI: 10.1055/s-0040-1717087
Original Article

Surgical Resection of Hepatoblastoma: Factors Affecting Local Recurrence

Alaa Younes
1   Department of Surgical Oncology, Children's Cancer Hospital, Cairo, Egypt
,
Ahmed Elgendy 
2   Surgical Oncology Unit, Department of Surgery, Tanta University, Tanta, Egypt
,
Sayed Fadel
3   Department of Pediatric Oncology, National Cancer Institute—Cairo University, Cairo, Egypt
4   Department of Pediatric Oncology, Children's Cancer Hospital, Cairo, Egypt
,
Marwa Romeih
5   Department of Radiology, Helwan University, Cairo, Egypt
6   Department of Radiology, Children's Cancer Hospital, Cairo, Egypt
,
Madeeha Elwakeel
6   Department of Radiology, Children's Cancer Hospital, Cairo, Egypt
,
Asmaa Salama
7   Department of Pathology, National Cancer Institute—Cairo University, Cairo, Egypt
8   Department of Pathology, Children's Cancer Hospital, Cairo, Egypt
,
Magda Azer
9   Department of Anesthesia, National Cancer Institute, Cairo University, Cairo, Egypt
10   Department of Anesthesia, Children's Cancer Hospital, Cairo, Egypt
,
Gehad Ahmed
11   Department of Surgery, Helwan University, Cairo, Egypt
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Abstract

Introduction This study aimed to investigate potential factors contributing to local recurrence after surgical resection of hepatoblastoma (HB).

Materials and Methods This retrospective study involving all patients with HB who underwent nontransplant surgery at our tertiary center between July 2007 and July 2018. Data were analyzed regarding microscopic surgical resection margin, tumor multifocality and extracapsular tumor extension in correlation with local recurrence. These relations were assessed by logistic regression.

Results The study included 133 patients with a median age of 1.3 years (range: 0.5–12.8 years). They were classified into 99 cases (74.44%) standard risk and 34 cases (25.56%) high risk. Delayed surgical resection was adopted in all patients. Follow-up to July 2019 revealed that 23 patients (23/133, 17.3%) developed local recurrence, whereas the remaining 110 were locally disease free. Microscopic positive margin (R1) was detected in 29 patients, 8 of them had local recurrence (p = 0.097). Regarding tumor multifocality, there were 12 patients who had multifocal lesions, 3 of them developed local recurrence (p = 0.459). Forty-four patients had extracapsular tumor extension in their pathological reports, 12 of them had local recurrence (p = 0.032).

Conclusion Extracapsular tumor extension was a significant prognostic factor of local recurrence after surgical resection of HB. R1 margin does not necessarily require a second resection, and it could achieve accepted results when combined with adjuvant platinum-based chemotherapy. However, patients who are not eligible for surgical resection must be transferred for primary transplantation to obtain favorable outcome.

Keywords

hepatoblastoma - children - surgical resection - local recurrence - extracapsular tumor extension

Authors' Contributions

Study design: All authors. Patients' management: All authors. Data collection: A.E. Data analysis: A.E. and G.A. Manuscript writing: A.E. Manuscript critical revision: A.E., A.Y., and G.A. All authors read and approved the final manuscript.




Publication History

Received: 26 April 2020

Accepted: 16 August 2020

Article published online:
19 September 2020

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