Endosurgery in the treatment of children with liver tumors

Introduction. The basic technique for treating patients with liver neoplasms is a surgical one. Currently, there is a trend to decrease a traumatic impact. One of the options for this is to develop and to implement minimally invasive surgical techniques which make postoperative period and rehabilitation easier.

Purpose. To find out the most optimal tactics for surgical treatment of children with liver tumors.

Material and methods. In 2014-2020, 26 patients, aged 0-17 years, with liver tumors were treated in Morozov Children’s City Clinical Hospital. 16 boys (61.5%) and 10 girls (38.5%). 17 patients with hepatoblastomas (68%); 2 (8%) in twos - hepatocellular cancer, embryonic liver sarcomas and focal nodular hyperplasias; 1 (4%) by ones - adenoma and hamartomas. In the morphological picture, hepatoplastoma was the most common (16 patients). 25 liver resections were performed; in 5 out of them (20%) (patients aged 3-9 years) minimally invasive technologies were used.

Results. Surgical time was significantly shorter in patients who were operated on with laparoscopic access (30–60 minutes), if to compare with laparotomic access (180-270 minutes). The volume of intraoperative blood loss in laparotomic access is more than 5 times larger than in laparoscopic access. In the group of patients operated on with the open access, intraoperative complications were noted in 2 (8%) cases: lethal outcome (4%) and injury of the extrahepatic biliary tract (4%).

Conclusion. Laparoscopic techniques reduce surgical time and blood loss. They also prevent complications both during surgery and in the postoperative period, shorten the hospital stay and promote early patient’s mobilization and early enteral feedings as well as early chemotherapy; they reduce pharmpreparation loading and prepare conditions for radical surgery