Outcome and morbidity of liver surgery in children: a single-centre, 47-year experience

Abstract

Abstract Background The outcome and survival of children with both benign and malignant liver tumours, over a 47-year period was recorded at The National Paediatric Cancer Centre, Our Lady’s Children’s Hospital (OLCHC), Crumlin. The retrospective study documents the impact of improved chemotherapy, multidisciplinary team approach and specific paediatric hepatobiliary surgical training on morbidity, outcome and survival. Methods A retrospective review of the hospital records of all children who presented with a primary liver tumour (benign or malignant) or a primary malignancy significantly involving the liver was undertaken. A review of the management of all such patients at OLCHC, between 1964 and 2011 was performed. This retrospective study reports on two distinct periods, group 1 (1964–1990, N = 21 patients, previously reported) and group 2 (1994–2011, N = 33). Follow-up for all group 2 patients ended in November 2014. Results A marked difference in survival was noted between the groups with 91% overall survival in group 2 patients as compared to 28% in group 1. Significant complications were documented in group 1 but were uncommon in group 2. Conclusion The improvement in mortality and morbidity reflects improved staging and chemotherapy in all patients with a malignant disease but also improved surgical strategies and multi-disciplinary team management (MDT). Specialist training in liver surgery had a significant impact on post-operative morbidity. The results suggest that in certain circumstances, rare and complex liver surgery may be performed in small centres if the necessary supports and experience co-exist.

Keywords

• Hepatoblastoma
• Paediatric liver resection
• Neoadjuvant chemotherapy
• Liver tumours, Morbidity and survival