Surgical management of giant liver tumor involving the hepatic hilum of children.

Background: Surgical management of giant liver tumors involving the hepatic hilum tends to be very difficult. The present study assessed the feasibility and safety of resection of such liver tumors.

Methods: We evaluated 27 patients with liver tumors involving the hepatic hilum. The patients ranged in age from 3 months to 14 years (mean, 4.2 years). Of the 27 cases, 23 were resected completely during the past 10 years. The other four cases did not undergo operation because of their parents' decisions to discontinue treatment; these cases had multiple space-occupying lesions in addition to tumors involving the hepatic hilum. Before resection, the tumor was fully exposed and an occluding tape was placed around the vena cava when necessary.

Results: The hepatectomies were performed under intermittent portal triad clamping; 23 cases were successfully resected without postoperative mortality or morbidity. The mean operation duration was 205 min and mean blood loss was 120 ml. Pathological diagnoses included hepatoblastoma (n = 9), endotheliosarcoma (n = 1), mesenchymal hamartoma (n = 4), teratoma (n = 1), adenoma (n = 3), and hepatocellular carcinoma (n = 4). The nine cases with benign liver tumors were healthy at follow-up at 11 months to 9 years after operation. Of the 14 cases with malignant tumors, six died from recurrence, metastasis, or other complications. The other eight cases were still alive without clinical tumors.

Conclusions: Resecting giant liver tumors involving the main hepatic veins and/or the retrohepatic vena cava, although challenging, is feasible and safe.