Oncologic Outcomes of Parenchyma-Sparing Resection for Hepatoblastoma.

Purpose: Surgery is the cornerstone of therapy for hepatoblastoma (HB). While standard resection (SR) via hemi-hepatectomy and trisectionectomy has traditionally been the preferred surgical approach, parenchyma-sparing resection (PSR) has become increasingly popular. We sought to compare the characteristics and outcomes of patients who underwent PSR versus SR.

Methods: Single-institution retrospective cohort study of HB patients who underwent hepatectomy from February 8, 2012 to August 12, 2024. Patients with metastasis at diagnosis, who underwent transplant, or who received simultaneous SR and PRS were excluded. Primary outcomes included 5-year event-free (EFS) and overall survival (OS). Secondary outcomes included margin status, transfusion requirement, operative time, postoperative liver dysfunction, reoperation, and biliary complications.

Results: Forty-three patients met inclusion criteria (21 PSR, 22 SR). More patients in the PSR group presented with pre-treatment extent of disease (PRETEXT) I tumors, multifocal disease or underwent upfront resection, whereas the SR group more frequently displayed aggressive histology. No events were observed in the PSR cohort at a median follow-up of 4.8 years, corresponding to 100% estimated 5-year EFS and OS. The estimated 5-year EFS and OS in the SR cohort were 87%; however when controlling for histology, the EFS and OS was equivalent to the PSR group. Two patients in the PSR group had microscopically positive resection margins compared to none in the SR group. PSR was associated with lower intra- and postoperative transfusion requirements, shorter operative times, and less severe postoperative liver dysfunction.

Conclusion: In this single-institution retrospective study, PSR was associated with acceptable oncologic outcomes in spite of two patients having microscopically positive margins. In select patients with low PRETEXT stage, multifocal tumors, and favorable vascular relationships, PSR may represent a viable surgical option when technically feasible and within surgeon expertise.