Management of liver tumors in childhood
Section snippets
Clinical presentation
Most children with a primary liver tumor present with abdominal distention and a palpable mass in the upper abdomen often without other signs of severe disease.2, 3 Anemia is often present. Only in advanced stage of disease, the good overall status deteriorates and the children develop abdominal pain, weight loss, nausea, vomiting, and ascites, and in case of pulmonary metastases progressive respiratory problems. Jaundice, signs of hepatic insufficiency or an incidental rupture of the tumor
Principles of tumor resection
The procedure of tumor resection in children has recently been thoroughly described by several authors.1, 2, 4 We choose a transverse incision combined with midline xiphoid extension if necessary. We mobilize the liver completely and put tourniquets around the hepatoduodenal ligament, as well as the vena cave above and below the liver for clamping if necessary. However, we try to avoid the Pringle maneuver and leave the remaining liver in the circulation during the resection to preserve optimal
Hepatoblastoma
From many studies, it is clear that there is only a chance for cure from HB if, at some time during the treatment procedure, a grossly complete resection of the tumor can be performed. Most HB, on the other hand, show good response to some cytotoxic drugs if given as neo-adjuvant chemotherapy reducing the tumor size and accomplishing better resectability. On this basis, two principle strategies exist. In the United States, a surgical tumor resection whenever possible is advocated as the first
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