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Surgical management of intrahepatic vessels in children with stage III/IV hepatoblastoma

Background Hepatoblastoma (HB) is a rare childhood tumor. We investigated the effect of intraoperative management of the intrahepatic major vessels in children with HB. Methods Between April 2005 and August 2012, surgical resection was performed on 50 children with hepatoblastoma. These children were divided into a vessel‐ligation group (n=20) and a vessel‐repair group (n=30). In the vessel‐ligation group, the intrahepatic major vessels were ligated and removed together with the tumor and the affected liver lobe/liver parenchyma. In the vessel‐repair group, the affected intrahepatic major vessels were dissected and preserved as much as possible and the normal liver lobe/liver parenchyma and blood supply from these vessels were also preserved. The outcomes were analyzed by postoperative follow‐up. Results In the vessel‐ligation group, two patients gave up surgery, six patients underwent palliative resection, and 12 patients underwent en bloc resection; four patients died of liver failure and eight patients fully recovered and were discharged. In the vessel‐repair group, all 30 patients underwent en bloc resection and were discharged after satisfactory healing. After a follow‐up time of 5‐36 months (median: 20 months), two patient in the vessel‐ligation group survived and 22 patients in the vessel‐repair group survived. Conclusions Patients with HB can be successfully treated by tumor resection with vascular repair. This method prevents postoperative liver failure, ensures patient safety during the perioperative period, and allows for early chemotherapy.