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.

Objective: Effective treatment for acute limb-threatening lower extremity (LE) thrombosis involves thrombolysis in addition to anticoagulation. There is limited available data on the outcomes and safety of catheter directed thrombolysis (CDT) to help guide its use in pediatrics. Procedure: Single-center retrospective medical record review of children (<21 years of age) that received CDT for LE and inferior vena cava (IVC) thrombosis over a 5-year span at a pediatric tertiary care center. Results: A total of 29 patients were identified for inclusion in the study, 76% (n=22) received overnight CDT while 24% (n=7) received tissue plasminogen activator (tPA) as a bolus dose during a single interventional procedure. The median age of the cohort was 15.8 years (range 0-19.1). All patients were treated with a course of anticoagulation. The thromboses represented were extensive, with 93% (n=27) being occlusive and affecting multiple venous segments. Thrombus resolution occurred in 35% (n=10) of patients. Rivaroxaban use during the course of anticoagulation and estrogen-containing hormonal therapy use prior to diagnosis were associated with thrombus resolution, while Hispanic ethnicity was associated with thrombus persistence. There was one major and 3 minor bleeding events that occurred as a complication of thrombolysis and no treatment related deaths. Conclusions: The administration of tPA, whether by CDT or as an intra-procedural bolus, for extensive LE and IVC thromboses is effective and safe in children when combined with a course of anticoagulation.