Association between surgical margins and long-term outcome in advanced hepatoblastoma

Background: Many patients with hepatoblastoma present with unresectable disease. Neoadjuvant therapy has improved resectability rates to as high as 70% to 90%. Despite this improvement, many patients will be left with tumors that are of borderline resectability. The authors hypothesize that favorable outcomes may be achieved even with resection margins less than 1 cm thus sparing the need for liver transplantation. Methods: Between January 1981 and March 2003, 23 patients age less than 16 years with a diagnosis of hepatoblastoma undergoing surgical resection were identified. The clinical characteristics, pathologic resection margins, and survival status were reviewed. Results: Eighteen (78%) of the patients were alive with no evidence of recurrence at last follow-up. Thirteen (56.5%) had greater than or equal to1 cm resection margins, whereas 10 (43.5%) had resection margins less than 1 cm. Eleven (47.8%) presented with PRETEXT III tumors. There was no significant difference in survival rate between resection margins less than 1 cm and greater than or equal to1 cm (P =.13; 95% Cl 0.91 to 2.61). Thirteen patients (56.5%) presented with synchronous pulmonary metastatic disease,where survival was significantly worse (P=.04; 95% Cl 1.10 to 2.50). Subgroup analysis confirmed that margins less than 1 cm did not significantly affect survival after controlling for pulmonary metastatic disease (P=.56; 95% Cl 0.71 to 3.61). Conclusions: Surgical resection with margins less than 1 cm are associated with survival that is equivalent to resection with margins greater than or equal to1 cm. Our findings suggest it is preferable to preserve key structures with a small resection margin and therefore spare the need for liver transplantation in patients with advanced hepatoblastoma.