J.Jpn. Surg. Soc.. 79(9): 1008-1012, 1978

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Report on the annual meeting

SURGICAL TREATMENT OF MALIGNANT LIVER TUMORS IN CHILDREN―COMBINATION WITH CHEMOTHERAPY AND HEPATIC DEVASCULARIZATION AGAINST THE ADVANCED LIVER TUMOR

In the past 16 years (1962-1977), we have experienced 14 cases with primary malignant liver tumors in children. Eleven cases were hepatoblastomas, two liver-cell carcinomas and one malignant mesodermal tumor. All of them were advanced tumors of stage III to IV. Seven patients are alive, among those 3 have lived more than 2 years and 3 are strongly prospective to be cured. The rest one is malignant mesodermal tumor of the liver with poor prognosis.
Recently, we have treated two patients with long term preoperative chemotherapy followed by the removal of the tumor. Case 1 was 14 months boy with initially unresectable hepatoblastoma, 70% well differentiated type and 30% poorly differentiated type, who received the administration of vincristine and cyclophosphamide preoperatively. After 9 months, the tumor became smaller and could be completely removed by right hepatic lobectomy. The value of serum α₁-fetoprotein decreased rapidly after the operation from 2.2 × 10⁵ ng/ml to under 5 ng/ml with a half time of one day. Case 2 was 11 years and 5 months girl with immature type hepatoblastoma, inoperable, whose tumor decreased the size by the same preoperative administration of vincristine and cyclophosphamide. These suggest that preoperative chemotherapy may be effective for some liver tumors.
In the case of unresectable liver tumor, we are also applying the method of gradual portal vein occlusion using ameroid ring accompanied with hepatic artery ligation from which anti-tumor agents are continuously injected. This method can induce an atrophy of the hepatic lobe and a decrease in size of the tumor effectively.

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