O2189: Non-Anatomic Resection for Hepatoblastoma is Associated with Favorable Outcomes

Background: Surgical resection is the cornerstone of therapy for children with hepatoblastoma (HB). Anatomic resection (AR), defined as hemi-hepatectomy or trisectionectomy, has traditionally been the preferred surgical approach. However, in effort to maximize remnant liver volume and minimize morbidity, non-anatomic resection (NAR) has become increasingly popular. We sought to compare the clinical characteristics and outcomes of patients who received NAR compared to AR at our institution.

Methods: Retrospective chart review was performed for patients who underwent hepatectomy for HB at a single quaternary care center from January 1, 2012 to December 31, 2024. Primary outcomes included 5-year event-free and overall survival. Intra-operative blood-transfusion requirement was assessed as a secondary outcome. Patients with metastasis at diagnosis and those who underwent liver transplant as their primary surgical treatment were excluded.

Results: We identified 51 patients who underwent hepatectomy for HB during our study period, of which 20 (39%) received NAR. NARs included sectionectomy (N = 8), bisegmentectomy (N = 2), segmentectomy (N = 8), and wedge resection (N = 2). Age, gender, PRETEXT, and rates of vascular invasion were similar between groups. A higher percentage of patients in the NAR group presented with multifocal disease (40% vs. 13%, p = 0.036) and received up-front surgery (65% vs. 7%, p < 0.001). A lower percentage of patients in the NAR group required intra-operative blood transfusion (45% vs. 75%, p = 0.001). Two patients in the NAR group had positive resection margins compared to none in the AR group (p = 0.072). Compared to the AR group, patients in the NAR group were found to have higher event-free (100% vs 74%, p = 0.025) and overall (100% vs. 79%, p = 0.051) survival at 5 years.

Conclusion: NAR was associated with favorable outcomes at our institution and should be considered for surgical management for children with HB when technically feasible.