Alaa Younes1, Ahmed Elgendy2, Sayed Fadel3,4, Marwa Romeih5,6, Madeeha Elwakeel6, Asmaa Salama7,8, Magda Azer9,10, Gehad Ahmed11. 1. Department of Surgical Oncology, Children's Cancer Hospital, Cairo, Egypt. 2. Surgical Oncology Unit, Department of Surgery, Tanta University, Tanta, Egypt. 3. Department of Pediatric Oncology, National Cancer Institute-Cairo University, Cairo, Egypt. 4. Department of Pediatric Oncology, Children's Cancer Hospital, Cairo, Egypt. 5. Department of Radiology, Helwan University, Cairo, Egypt. 6. Department of Radiology, Children's Cancer Hospital, Cairo, Egypt. 7. Department of Pathology, National Cancer Institute-Cairo University, Cairo, Egypt. 8. Department of Pathology, Children's Cancer Hospital, Cairo, Egypt. 9. Department of Anesthesia, National Cancer Institute, Cairo University, Cairo, Egypt. 10. Department of Anesthesia, Children's Cancer Hospital, Cairo, Egypt. 11. Department of Surgery, Helwan University, Cairo, Egypt.
Abstract
INTRODUCTION: This study aimed to investigate potential factors contributing to local recurrence after surgical resection of hepatoblastoma (HB). MATERIALS AND METHODS: This retrospective study involving all patients with HB who underwent nontransplant surgery at our tertiary center between July 2007 and July 2018. Data were analyzed regarding microscopic surgical resection margin, tumor multifocality and extracapsular tumor extension in correlation with local recurrence. These relations were assessed by logistic regression. RESULTS: The study included 133 patients with a median age of 1.3 years (range: 0.5-12.8 years). They were classified into 99 cases (74.44%) standard risk and 34 cases (25.56%) high risk. Delayed surgical resection was adopted in all patients. Follow-up to July 2019 revealed that 23 patients (23/133, 17.3%) developed local recurrence, whereas the remaining 110 were locally disease free. Microscopic positive margin (R1) was detected in 29 patients, 8 of them had local recurrence (p = 0.097). Regarding tumor multifocality, there were 12 patients who had multifocal lesions, 3 of them developed local recurrence (p = 0.459). Forty-four patients had extracapsular tumor extension in their pathological reports, 12 of them had local recurrence (p = 0.032). CONCLUSION: Extracapsular tumor extension was a significant prognostic factor of local recurrence after surgical resection of HB. R1 margin does not necessarily require a second resection, and it could achieve accepted results when combined with adjuvant platinum-based chemotherapy. However, patients who are not eligible for surgical resection must be transferred for primary transplantation to obtain favorable outcome. Thieme. All rights reserved.
INTRODUCTION: This study aimed to investigate potential factors contributing to local recurrence after surgical resection of hepatoblastoma (HB). MATERIALS AND METHODS: This retrospective study involving all patients with HB who underwent nontransplant surgery at our tertiary center between July 2007 and July 2018. Data were analyzed regarding microscopic surgical resection margin, tumor multifocality and extracapsular tumor extension in correlation with local recurrence. These relations were assessed by logistic regression. RESULTS: The study included 133 patients with a median age of 1.3 years (range: 0.5-12.8 years). They were classified into 99 cases (74.44%) standard risk and 34 cases (25.56%) high risk. Delayed surgical resection was adopted in all patients. Follow-up to July 2019 revealed that 23 patients (23/133, 17.3%) developed local recurrence, whereas the remaining 110 were locally disease free. Microscopic positive margin (R1) was detected in 29 patients, 8 of them had local recurrence (p = 0.097). Regarding tumor multifocality, there were 12 patients who had multifocal lesions, 3 of them developed local recurrence (p = 0.459). Forty-four patients had extracapsular tumor extension in their pathological reports, 12 of them had local recurrence (p = 0.032). CONCLUSION: Extracapsular tumor extension was a significant prognostic factor of local recurrence after surgical resection of HB. R1 margin does not necessarily require a second resection, and it could achieve accepted results when combined with adjuvant platinum-based chemotherapy. However, patients who are not eligible for surgical resection must be transferred for primary transplantation to obtain favorable outcome. Thieme. All rights reserved.