Two-stage laparoscopic resection of giant hepatoblastoma in infants combined with liver partial partition and artery ligation

Purpose: Laparoscopic resection of giant hepatoblastoma (HB) in children has long been a subject of controversy. Here a new procedure of two-stage laparoscopic resection of giant HB in infants was firstly reported and the feasibility was discussed. Methods The clinical data of 3 infants with HB were retrospectively reviewed, all of which received 3–5 cycles of neoadjuvant chemotherapy. Stage one laparoscopic selective hepatic artery ligation and liver partial partition were performed. Stage two laparoscopic hepatectomy was performed two weeks later. Results The results demonstrated that: 1) The tumors shrank considerably in size and had relatively clear boundaries after neoadjuvant chemotherapy; 2) After stage one surgery, the tumor volume further reduced, while the intratumoral necrosis expanded. 3) Two weeks later, stage two laparoscopic hepatectomy was performed successfully; 4) None of the cases had intraoperative complications such as tumor rupture, air embolism, hemorrhage, biliary fistula or liver failure, and there was no recurrence or metastasis during follow-up. Conclusions Two-stage laparoscopic hepatectomy associating selective hepatic artery ligation and liver partial partition for HB in infants has the benefits of small invasiveness, fast recovery, improved safety and high feasibility. However, more cases and longer follow-up are needed to assess its long-term efficacy.