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Outcomes of Extended Hepatic Resection for POST-TEXT III and IV Hepatoblastoma: a single center experience

Objective: To investigate the long-term outcomes of extended hepatectomy for POST-TEXT III and IV hepatoblastoma. Methods: The clinical data of 35 patients with POST-TEXT III and IV hepatoblastoma from January 2009 to June 2019 were analyzed retrospectively. Results: There were 34 cases of POST-TEXT III and 1 cases of POST-TEXT IV, respectively. All 35 cases underwent hepatic resection, including 7 cases of hepatic trisectionectomy, 8 cases of extended hemihepatectomy, 4 cases of irregular hepatectomy, 12 cases of mesohepatectomy and 4 cases of ALPPS procedure. 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). The 5-year overall survival rate and event-free survival rate was 79.2% and 73.7%, respectively. According to the classification of tumor margin distance, the 5-year overall survival rates of the tumors with margin > 1cm, 0.5-1cm, < 0.5cm and close to the tumor margin were 100%, 78.0%, 83.3% and 53.3%, respectively (P=0.371). Seven patients developed recurrence which occurred within 1 year after tumor resection. Conclusion: Non-transplant extended hepatic resection is a feasible approach for POST-TEXT III and IV hepatoblastomas. On the basis of mastering the Glisson approach and ensuring a certain resection margin, it is possible to achieve a similar oncological outcome to liver transplantation.