WOFAPS 2025 8th World Congress of Pediatric Surgery

Ege Ekiyor, İlayda Sağpazar, Kutay Bahadır, Ergun Ergün, Suat Fitöz, Meltem Bingöl-Koloğlu

Ankara University Health Practice and Research Hospital, Department of Pediatric Surgery, Ankara

Purpose:
To report our institutional experience with the surgical management of pediatric patients diagnosed with hepatoblastoma and to evaluate their clinical outcomes.

Methods:
This retrospective study included pediatric patients who underwent surgery for hepatoblastoma at our institution between 2006 and 2024. Demographic characteristics, PRETEXT stage at diagnosis, type of surgical intervention, tumor histopathology, perioperative complications, and clinical outcomes were recorded and analyzed.

Results:
A total of 63 patients (38 males, 25 females) with a mean age of 35 months (range: 5–156 months) were included. The majority of patients (63.5%) presented with PRETEXT stage III disease. Five patients had distant metastases and locally advanced tumors, while tumor rupture prior to surgery occurred in two patients. Fifty-six patients (87%) received neoadjuvant chemotherapy followed by delayed surgical resection. Seven patients (13%) underwent primary liver resection.
Surgical procedures included right hepatectomy (n=28), extended right hepatectomy (n=12), left hepatectomy (n=10), extended left hepatectomy (n=8), central hepatectomy (n=3), liver transplantation (n=2), and right hepatectomy combined with Whipple procedure (n=1). Negative surgical margins were achieved in all cases.
Surgery-related complications occurred in six patients (9.5%), including bile leakage from the cut surface (n=2), late-presenting diaphragmatic hernia (n=2), and late-onset bile duct stricture (n=1).
Three patients died: two were older than 10 years, and one presented with both locally advanced disease and age >10 years. The 5-year disease-free survival rate was 92.1%.

Conclusion:
Our findings highlight the safety and efficacy of surgical resection in the treatment of hepatoblastoma. Complete tumor resection with negative margins yields excellent outcomes with minimal complications. Extended liver resections are feasible in specialized centers. Older age and locally advanced disease at diagnosis may predict poorer prognosis.