RT Book, Section
A1 Meyers, Rebecka L.
A1 Tiao, Greg M.
A2 Ziegler, Moritz M.
A2 Azizkhan, Richard G.
A2 Allmen, Daniel von
A2 Weber, Thomas R.
SR Print(0)
ID 1100439511
T1 Liver Tumors
T2 Operative Pediatric Surgery, 2e
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-162723-8
LK accesssurgery.mhmedical.com/content.aspx?aid=1100439511
RD 2024/04/18
AB Liver  tumors  are  rare  in  children  accounting  for  about  1.5%  of  all  childhood  malignancies.  Primary  pediatric  malignant  tumors  include  hepatoblastoma  (HB),  hepatocellular  carcinoma  (HCC),  rhabdoid  tumors,  and  sarcomas.Age  at  presentation  and  level  of  alpha  fetoprotein  (AFP)  are  often  the  keys  to  differential  diagnosis.HB  accounts  for  about  80%  of  the  malignant  tumors  in  children  and  the  incidence  appears  to  be  increasing.Pre-treatment  extent  of  disease  (PRETEXT)  is  based  on  cross-sectional  imaging  assessment  of  the  extent  of  tumor  involvement  of  the  4  main  sections  of  the  liver.Surgical  resection  is  recommended  (1)  by  lobectomy  or  segmentectomy  at  diagnosis  for  PRETEXT  I  and  II,  (2)  by  lobectomy  or  trisegmentectomy  after  neoadjuvant  chemotherapy  for  PRETEXT  III  (or  POSTTEXT  I,  II  or  III  and  no  major  venous  involvement  −V  and  −P),  and  (3)  by  liver  transplant  or  extreme  resection  for  POSTTEXT  III+V+P,  and  for  any  PRETEXT  IV.Only  0.5  to  1%  of  all  Hepatocellular  Carcinoma  (HCC)  manifest  before  20  years  of  age  and  more  than  two-thirds  of  those  are  older  than  10  years  of  age.Chemotherapy  is  ineffective  for  HCC  so  primary  radical  tumor  resection  should  be  considered  and  all  available  techniques  should  be  used  to  achieve  this  goal.