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Is laparatomy the first step in treatment of childhood liver tumors?--The experience from the German Cooperative Pediatric Liver Tumor Study HB-89.

In the cooperative study on childhood liver tumors (HB-89) of the German Society for Pediatric Oncology and Hematology an initial laparotomy was recommended for all children with a primary liver tumor. Now a more differentiated surgical strategy has been worked out on the basis of study data. Patient's age, alpha-fetoprotein or other tumor markers, imaging techniques and histological investigations were predictive for differential diagnosis in most, but not all cases. Surgical complications occurred infrequently, there was no perioperative mortality. Results of therapy were satisfactory in hepatoblastoma, but poor in hepatocellular carcinoma, since chemotherapy and radiation were not effective on this tumor. In conclusion, primary chemotherapy without histological confirmation is justified, if in children between six months and three years of age with a high serum-alpha-fetoprotein a hepatoblastoma is certain, and the tumor involves both lobes of the liver. All other patients should have an initial laparotomy for resection of small or biopsy of large tumors. In case of hepatocellular carcinoma a primary resection should be attempted on principle.