Liver tumours in children

Since 1955, 56 children (29 M: 27 F) with primary liver tumours have been treated at the Royal Children's Hospital. Ranging in age from neonates to 14 years, they most frequently presented with an abdominal mass. The position, size, and vascularity of the tumour were assessed preoperatively by ultrasound +/− angiography. An elevated serum alpha-feto-protein was confirmatory evidence of a hepatoblastoma. In the malignant group (33), 70% of the children had tumour resection with 5 “surgical” deaths. The long-term survival in the resected group was 15/23 (65%). No children survived without resection. In the benign group (23), 8 children had an arteriovenous malformation (7 neonates). Six are alive and well following hepatic lobectomy with 1 dying of cardiac failure before the diagnosis was established. The other benign tumours were either removed by local excision (10), lobectomy (3), or biopsied (2). All children are alive and well. In those children requiring hepatic lobectomy, hypothermia and hypotension were used as adjuncts to anaesthesia. The commonest operative complication was blood loss (50%). The technique of total vascular isolation was introduced in 1975 and reduced the incidence to 16%. The use of chemotherapy enabled subsequent tumour resection in 4 of 5 tumours that were initially unresectable. Chemotherapy was also given postoperatively to 8 of 17 patients surviving resection.