Surgical Results
All 35 cases underwent hepatic resection, including 7 cases of hepatic
trisectionectomy (4 right, 3 left), 8 cases of extended hemihepatectomy
(4 right hemihepatectomy with additional segment IV, 4 left
hemihepatectomy with additional segment V), 4 cases of irregular
hepatectomy, 12 cases of mesohepatectomy and 4 cases of ALPPS procedure
(Table 2). The average operation time was 262.29 ± 107.16 minutes
(range, 120-520 minutes), and the average blood loss was 236.86 ± 212.41
ml (range, 20-700 ml). Pringle maneuver and Glissonean approach was used
in 4 and 22 patients, respectively. The average blood loss of patients
with Glissonean approach (147.73 ± 137.46ml) was significantly less than
that of patients without the approach (387.69 ± 235.69ml; P = 0.001).
Because of the injury of the bile duct, additional hepaticojejunostomy
was performed in 3 patients who did use Glissonean pedicle approach.
Postoperative complications occurred in 10 patients: bile leak in 9
patients, of which 4 patients were resolved by drainage and the rest
were absorbed spontaneously; Budd Chiari syndrome in 1 patient, of whom
was died of the emergency surgery. The incidence of bile leak was 27.3%
in 6 cases who used Glissonean pedicle approach and 23.1% in 3 cases
without the approach (P = 0.784). The postoperative liver function of
all patients, including 4 patients undergoing ALPPS procedure, recovered
gradually within one month. The relationship between POST-TEXT
classification, operation time, blood loss, bile leakage and the type of
surgery was listed in Table 2.
Histological analysis revealed mixed epithelial/mesenchymal
hepatoblastoma in 20 patients, embryonal hepatoblastoma in 6 patients
and fetal hepatoblastoma in 9 patients. Microscopically positive
resection margin was confirmed by pathology in one patient, the
resection margins of rest 34 patients were negative. According to the
classification of tumor margin distance, there were 7 cases (20.0%)
with margin > 1 cm, 15 cases (42.9%) with margin 0.5-1 cm,
7 cases (18.9%) with margin < 0.5 cm, and 6 cases (16.2%)
with close to tumor margin. AFP returned to normal after surgery in 30
cases. The average time of AFP recovery was 11.8 ± 10.5 weeks (4-60
weeks), 90% of them recovered within 12 weeks. Further adjuvant
chemotherapy was given in all patients and the average cycle was 4.76 ±
2.36 (2-15 cycles) after operation.