Surgical resection of pediatric PRETEXT III and IV hepatoblastoma: A retrospective study investigating the need for preoperative chemotherapy

Xiongwei Wu; Jianyong Wang; Yuhe Duan; Yusheng Liu; Yao Liu; Xin Chen; Nan Xia; Qian Dong

doi:10.3389/fped.2022.878095

Surgical resection of pediatric PRETEXT III and IV hepatoblastoma: A retrospective study investigating the need for preoperative chemotherapy

Front Pediatr. 2022 Dec 1:10:878095. doi: 10.3389/fped.2022.878095. eCollection 2022.

Authors

Xiongwei Wu^{1

2}, Jianyong Wang³, Yuhe Duan¹, Yusheng Liu¹, Yao Liu¹, Xin Chen¹, Nan Xia², Qian Dong^{1

2}

Affiliations

¹ Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
² Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
³ Department of Pediatrics, Yantai Yuhuangding Hospital, Shandong, China.

Abstract

Objective: This study analyzed the feasibility of upfront surgical resection for pediatric PRETEXT III and IV hepatoblastoma (HB).

Summary background data: Neoadjuvant chemotherapy is recommended for patients with PRETEXT III and IV HB to obtain a chance of curative surgery. However, chemotherapy can cause toxic side effects and adverse outcomes, and the PRETEXT staging system may overstage the patients. Therefore, whether preoperative chemotherapy is necessary for HB patients remains unclear.

Methods: The clinical data of 37 children who underwent surgical resection for PRETEXT III and IV HB at our hospital were obtained retrospectively. Patients were divided into the neoadjuvant chemotherapy group (NCG; n = 19) and the routine surgery group (RSG; n = 18). Clinicopathologic characteristics, treatment regimens, and outcomes were compared between the groups.

Results: The RSG had a lower incidence of portal vein involvement than the NCG (p < 0.002). The estimated 3-year event-free survival rates were similar (RSG: 89 ± 0.7% and NCG: 79 ± 0.9%, p = 0.3923). The RSG underwent fewer courses of chemotherapy than the NCG (five vs. six; p < 0.001). Furthermore, the RSG had lower incidences of febrile neutropenia, myelosuppression, and gastrointestinal reactions (all p < 0.05). The severity of surgery-related complications did not differ significantly.

Conclusion: Upfront surgical resection in children with PRETEXT III and IV HB is safe and feasible, and reduces the total number of courses and side effects of chemotherapy. The degree of vascular involvement is the most important consideration when evaluating resectability during diagnosis.

Keywords: hepatoblastoma (HB); liver vasculature; preoperative chemotherapy; surgery; surgical resection.