Evaluation of surgical strategies and long-term outcomes in pediatric hepatocellular carcinoma

Purpose: Hepatocellular carcinoma (HCC), the second most common pediatric malignant liver tumor after hepatoblastoma, represents 1% of all pediatric tumors. Methods A retrospective study was conducted on children with HCC treated at our center from March 2002-October 2022, excluding those with inadequate follow-up or records. Demographic data, initial complaints, AFP values, underlying disease, size and histopathological features of the masses, chemotherapy and long-term outcomes were analyzed. Results Fifteen patients (8 boys, 7 girls) with a mean age of 11.4 ±4.1 years (0.8-16.4 years) were analyzed. The majority presented with abdominal pain, with a median AFP of 3.9 ng/mL. Hepatitis B cirrhosis in one patient (6.6%), metabolic disease (tyrosinemia type 1) in two patients (13.3%) were the underlying disease. Histopathological diagnoses were Fibrolamellar HCC (n:8; 53.3%), HCC (n:6; 40%). Four of the 15 patients underwent liver transplantation, 9 underwent surgical resection. Due to late diagnosis, 2 patients were considered inoperable (13.3%). The survival rate for the four patients who underwent liver transplantation was found to be 75%. Conclusion: The surgical treatment of various variants of HCC, can be safely performed in experienced centers with a multidisciplinary approach and outcomes are better than in adults.