Integration of A Dedicated Management Protocol in the Care of Pediatric Liver Cancer: From Specialized Providers to Complication Reduction
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In brief
In brief
Implementation of a dedicated multidisciplinary protocol with high-volume surgeons reduced perioperative complications in pediatric liver cancer patients from 52% to 20%. Major complications following hepatectomy were associated with worse event-free survival in hepatoblastoma patients, suggesting protocol-driven care may improve both surgical and oncological outcomes.
Written by the GCMD Library team from the article.
Introduction
Up to a third of children undergoing partial hepatectomy for primary hepatic malignancies experience at least one perioperative complication, with a presumed deleterious effect on both short- and long-term outcomes. We implemented a multidisciplinary treatment protocol in the management of these patients in order to improve complication rates following partial hepatectomy.
Methods
A retrospective chart review was completed for all patients < 18 years of age who underwent liver resection at our institution between 2002 and 2019 for primary hepatic cancer. Demographic, intraoperative, postoperative, pathologic, and outcome data were analyzed for perioperative complications using the CLASSIC and Clavien-Dindo (CD) scales, event-free survival (EFS) and overall survival (OS).
Results
A total of 73 patients were included in the analysis with 33 prior-to and 40 after dedicated provider protocol implementation. Perioperative complication rates decreased from 52% to 20% (p=0.005) with major complications going from 18% to 10% (p=0.31). On multivariable logistic regression, protocol implementation was associated with a reduction in any (OR 0.29 [95% CI 0.09 – 0.89]) but not major complications. On multivariate cox models, post protocol implementation was associated with improved event free survival (EFS) (HR 0.19 (0.036 – 0.195). Among patients with a diagnosis of hepatoblastoma (n=62), the occurrence of a major perioperative complication was associated with a worse EFS (HR=5.45, p=0.03) on multivariate analysis, however this did not translate into an impact on overall survival.
Conclusions
Our results demonstrate that, for children with primary liver malignancies, a dedication of patients to high-volume surgeons can improve rates of complications of liver resections and may improve the oncological outcome of hepatoblastoma.