Resection for primary liver tumors in children: an experience of 52 cases at one institution.

OBJECTIVE: To review the authors' experiences of liver resection for primary tumors in children. MATERIAL AND METHOD: The children who had undergone liver resection for any masses between January 1996 and December 2005 were studied. Their clinical data and pathological reports were reviewed for descriptive study. Surgical data including the extent of lesions, type of resection, and post-operative complications within 60 days after surgery were analyzed. Data are expressed as mean and standard deviation (SD). RESULTS: Fifty-two children, with a male to female sex ratio of 28:24, underwent resection for primary liver tumors. Their average age was 36.64 +/- 4.05 months and average weight was 12.02 +/- 6.76 Kg. Asymptomatic mass was the main complaint. Ultrasonography was the initial investigation and CT scan was performed later in all patients with suspected liver mass to confirm the diagnosis and to assess the resectability. CT scan was also useful for the diagnosis of liver tumor in six cases which ultrasonography could not differentiate from other abdominal tumors. The tumors were assessed to be unresectable in 28 of 52 (53.8%) patients who had preoperative chemotherapy and became resectable later. Surgical procedures were as follows: 39 hepatic lobectomies, six extended hepatic lobectomies, and seven segmentectomies. Mean operative time was 251.04 +/- 89.22 min. Mean ICU stay was 2.8 +/- 3.2 days. Pathology revealed 38 hepatoblastomas, five hemangioendotheliomas, four hepatomas, two harmatomas, and three other lesions. Post-operative complications occurred in 15 children (29%) including intra-abdominal bleeding (3), subphrenic collection (1), acute liver failure (3), wound infection (2), and atelectasis (6). No mortality within 60 days after surgery occurred. Most of the patients were discharged within 10 days after surgery. CONCLUSION: With the advancement of preoperative evaluation, more accurate diagnosis of liver tumors, and the extent of lesions has led to the proper more effective surgical resection and further treatment, then led to zero mortality rate related to liver resection for primary tumors in the present series. Although there were significant complications, mostly minor problems and all both minor and major complications were manageable; their fatal potentials should not be underestimated.

Factors influencing outcome after hepatic portoenterostomy for biliary atresia: a logistic regression analysis.

BACKGROUND/OBJECTIVE: The association of many factors with the outcome in Biliary atresia (BA) after hepatic portoenterostomy has drawn the attention of many pediatric hepatologists and hepatobiliary surgeons. Understanding these factors will become an important subject in prediction of the postoperative status and in indicating further proper management. MATERIAL AND METHOD: During the last 9 years, 159 BA babies were treated by hepatic portoenterostomy. The authors reviewed the following factors and how they related to outcome: age at operation, total bilirubin (TB) level, type of BA, postoperative bile drainage, hepatic histological features at operation, preoperative and postoperative cholangitis. A multiple logistic regression analysis was used to indicate the factors which significantly influenced the outcome. RESULTS: Of the 159 BA babies, clearing of jaundice confirmed by the color of stool and postoperative serum bilirubin level less than 2 mg % was observed in 54 patients (Group A). Bile drainage with mild jaundice (TB 2-5 mg %) was detected in 65 patients (Group B). The operation failed to create bile flow clinically and biochemically in 40 patients (Group C). Some patients in the last group died during follow-up due to hepatic disease. The multiple logistic regression analysis revealed that the age at operation (> 8 weeks of age), and the presence of portal and parenchymal inflammation at operation significantly related to the failure of portoenterostomy which was followed by portal hypertension with or without esophageal varices. The presence of cholangitis was also significantly related to a poor outcome. CONCLUSION: The age at operation, portal and parenchymal inflammation and the presence of cholangitis are significant factors which relate to the poor prognosis of BA. Recognition of these will lead to proper long-term management.