Surgical resection of huge hepatic hepatoblastoma involving second, third hepatic hilum: a study of 59 cases

Abstract Background A considerable proportion of pediatric giant hepatoblastoma cases involve the second and third hepatic portals (GHSTP), which were previously considered unresectable. Surgical management of such GHSTP-involved cases is associated with significant technical challenges. This retrospective study was designed to assess the feasibility and surgical approaches for pediatric giant hepatoblastoma with involvement of the second and third hepatic portals. Methods From January 2006 to December 2024, 59 pediatric patients with giant hepatoblastoma involving the second and third hepatic portals (GHSTP) underwent partial hepatectomy. The therapeutic outcomes of these cases were retrospectively analyzed. Results All 59 patients underwent successful liver tumor resection. The operative duration ranged from 160 to 350 minutes, with a mean of 270 minutes. First hepatic portal clamping was performed in all cases. The resection approaches were as follows: 13 cases underwent resection of segments V-VIII; 12 cases, resection of segments IV-VIII; 6 cases, resection of segments I-IV; 10 cases, resection of segments I, IV, and VIII; 8 cases, resection of segments I, IV, V, and VIII; 4 cases, resection of segment I plus segments V-VIII; and 6 cases, resection of segment I plus segments IV-VIII. There was no mortality, and postoperative complications occurred in 8 cases. Conclusion Resection of giant hepatoblastoma involving the second and third hepatic portals remains technically challenging; however, with meticulous and accurate preoperative assessment coupled with a thorough understanding of hepatic anatomy, such tumor resection is feasible and can be performed with acceptable safety. Moreover, complete resection of this subset of tumors may effectively improve the long-term survival outcomes of patients with hepatoblastoma.