Central Liver Segments Resections vs Extended Hepatectomies in Children: Single-Center Experience
Akhaladze D.G. Rabaev G.S. Tverdov I.V. Merkulov N.N. Uskova N.G. Talypov S.R. Krivonosov A.A. Grachev N.S.
December 2024W.B. Saunders
Journal of Pediatric Surgery
2024#59Issue 12
Background: Central liver segments resection (CLSR) still is not widely used in pediatric surgery due to its technical difficulty, whereas this procedure is widely spread as a parenchyma sparing approach of centrally located liver tumors in adults. The aim of this study is to analyze the outcomes of CLSR in comparison with extended hepatectomy (EH) in children with different liver tumors. Methods: A single-center retrospective analysis of patients who received CLSR (n = 14) and EH (n = 44) from June 2017 to December 2023 was applied. Patients characteristics, preoperative, intra- and postoperative data were compared between 2 groups. Results: Preoperative CT-volumetry showed that future liver remnant volume was higher in CLSR group compared to EH (FLR-V; (54 ± 29 (40–91) % vs 40 ± 12 (17–73) %, p = 0.016). The intraoperative blood loss (200 [90–1150] (20–3000) ml vs 100 [30–275] (10–9000) ml, p = 0.088) and transfusion volume (310 [85–590] (0–1860) ml vs 150 [0–310] (0–4770) ml, p = 0.484) were similar in both groups, while operation time was longer in CLSR group (420 [320–595] (145–785) min vs 280 [203–390] (125–710) min), p = 0.011). There was no difference in biliary leakage (3 (21.4 %) vs 12 (27.3 %); p = 0.479), other complications (4 (28.6 %) vs 5 (11.4 %), p = 0.198) and complications ≥ IIIb by Clavien-Dindo (2 (14.3 %) vs 8 (18.2 %), p = 0.385) postoperatively. Conclusion: CLSRs allow to preserve more healthy liver parenchyma compared to EH with similar intraoperative and postoperative outcomes. «Extended mesohepatectomy» allows to achieve R0 resection when central liver tumor extends on the left lateral and/or right posterior section. Type of Study: Retrospective Comparative Study (Level of Evidence III).
Central liver resection , Hepatoblastoma , Mesohepatectomy , Pediatric surgery
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Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology Ministry of Health of Russian Federation, 1 Samory Mashela Str., Moscow, 117997, Russian Federation
University Medical Centre Corporate Fund, National Research Center for Maternal and Child Health, 32 Turan Str., Astana, 010000, Kazakhstan
Dmitry Rogachev National Medical Research Center of Pediatric Hematology
University Medical Centre Corporate Fund
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