Repeat hepatectomy for pediatric recurrent chemotherapy-resistant hepatoblastoma: a report of 18 cases.

BACKGROUND AND AIMS: Repeat hepatectomy for adult recurrent hepatocellular carcinoma significantly prolongs the overall survival, but repeat hepatectomy for pediatric recurrent hepatoblastoma (HB) is rarely reported, and the outcomes are warranted to be investigated. METHODS: All patients between May 2015 and December 2020 with recurrent HB after intended surgical cure were retrospectively evaluated. Clinicopathologic features, surgical details and outcomes were analyzed during a median following-up of 24 months after repeat hepatectomy. Survival analysis was performed using the Kaplan-Meier estimate. RESULTS: A total of 18 patients of recurrent HB undergoing repeat hepatectomy with radical cure intention were included. There were 11 males and 7 females. The median age was 29 months (range 5-87 months) at first hepatectomy, and the median time to the recurrence from the first hepatectomy was 7 months. The operating time of the repeat hepatectomy was 5.0 h (range 3.5-9.0 h) and the mean blood loss was 592 ml (range 50-3200 ml). Radical resection (R0) was achieved in 12 patients (66.7%), with a postoperative hospital stay of 7.9 ± 1.8 days. No serious postoperative complications or mortality occurred. The overall survival (OS) rate was 55.6% (10/18) and the event-free survival (EFS) rate was 33.3% (6/18). Those with no lung metastases, not high-risk stratification, and achieving R0 hepatectomy, anatomic hepatectomy had longer OS rate (all P < 0.05) after repeat hepatectomy. Two of three patients with re-recurrence HB undergoing salvage liver transplantation were alive with a tumor-free survival. CONCLUSIONS: Repeat hepatectomy for recurrent HB can be carried out safely. However, only a highly selected subgroup of patients might actually benefit from this procedure.

Pharmacokinetic evaluation of pancreatic arterial infusion chemotherapy with lipid emulsion as a drug carrier in an animal model.

The purpose of this study was to investigate the potential pharmacokinetic advantage of pancreatic arterial infusion chemotherapy with lipid emulsion as a drug carrier for pancreatic cancer in a dog model. The 20% Intralipid, as a solvent, was used in the experimental animals with 2 ml/kg (group A) and 1 ml/kg (group B). Normal sodium as a solvent was used as a control with 2 ml/kg (group C) and 1 ml/kg (group D), respectively. Cisplatin (4 mg/kg) was infused into the proximal segment of the splenic artery. The concentrations of cisplatin were measured in plasma of the portal vein and in the liver and pancreas of groups A and C. The area under the concentration-time curve (AUC), the maximum plasma concentration (C(max)), and the elimination half-life (t(1/2)) in plasma were calculated and compared statistically. Compared with group C, the AUC and C(max) of group A were significantly lower (P<0.01 and P<0.01, respectively), the t 1/2 was longer (P<0.05), and the tissue cisplatin concentration of the pancreas was higher (P<0.05). Compared with group D, the AUC and C(max) of group B were significantly lower (P<0.01 and P<0.01, respectively) and the t(1/2) was longer (P<0.01). Pancreatic arterial infusion chemotherapy with lipid emulsion as a drug carrier can increase the local concentration and prolong the retention time of a drug.