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A Multidisciplinary Approach to Pediatric Liver Cancer Decreases Perioperative Complications and Improves Outcomes.
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  • Richard Whitlock,
  • Sarah Jane Commander,
  • Tu-Anh Ha,
  • Huirong Zhu,
  • Jorge Portuondo,
  • John Goss,
  • Kamlesh Kukreja,
  • Daniel Leung,
  • Dolores Lopez-Terrada,
  • Prakash Masand,
  • HaiThuy Nguyen,
  • Jed Nuchtern,
  • David Wesson,
  • Andras Heczey,
  • Sanjeev Vasudevan
Richard Whitlock
Texas Children's Hospital
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Sarah Jane Commander
Duke University Medical Center
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Tu-Anh Ha
Baylor College of Medicine
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Huirong Zhu
Texas Children’s Surgical Oncology Program, Dan L. Duncan Cancer Center, Baylor College of Medicine
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Jorge Portuondo
Baylor College of Medicine
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John Goss
Baylor College of Medicine
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Kamlesh Kukreja
Texas Children's Hospital
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Daniel Leung
Baylor College of Medicine
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Dolores Lopez-Terrada
Baylor College of Medicine
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Prakash Masand
Texas Children's Hospital
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HaiThuy Nguyen
Baylor College of Medicine
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Jed Nuchtern
Texas Children's Hospital
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David Wesson
Texas Children's Hospital
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Andras Heczey
Texas Children's Hospital
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Sanjeev Vasudevan
Texas Children’s Surgical Oncology Program, Dan L. Duncan Cancer Center, Baylor College of Medicine
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Abstract

Introduction: Partial hepatectomy in children with primary hepatic malignancies has a complication rate as high as 30%. This has a negative effect on outcomes. We organized a multidisciplinary team (MDT) dedicated to the care of these patients to lower complication rates and improve outcomes. Methods: A retrospective chart review was completed for all patients < 18 years of age who underwent liver resection at our institution between 2002 and 2019 for primary hepatic cancer. Demographic, intraoperative, postoperative, pathologic, and outcome data were analyzed for perioperative complications using the CLASSIC and Clavien-Dindo (CD) scales, event-free survival (EFS) and overall survival (OS). Results: Ten (13%) of 73 patients experienced a major perioperative complication (CLASSIC or CD > 3); two (3%) died within 30 days of surgery. After the implementation of a dedicated MDT in 2014, the major perioperative complication rate decreased from 18% to 10%, and rates for all complications dropped from 52% to 20% (p=0.005). Older patient age (median 62 months vs. 50 months, p=0.05) and the presence of pulmonary metastases at diagnosis (p=0.01) were associated with increased rates of major perioperative complications. Among patients with a hepatoblastoma (n=62), the presence of a major perioperative complication was associated with a worse EFS (HR=5.45, p=0.03) on multivariate analysis. Patients treated following MDT implementation had improved EFS (HR=0.18, p=0.04). Conclusions: Our results demonstrate that, for children with primary liver malignancies, a MDT can decrease the rate of complications of liver resection and improve the oncological outcome of hepatoblastoma.