Background: Pediatric hepatocellular carcinoma (HCC) presents significant challenges due to its aggressive nature, with survival depending on complete resection. We aimed to assess outcomes between liver resection (LR) and liver transplantation (LT).
Methods: A total of 25 patients were retrieved, 4 of whom were classified as palliative at diagnosis. A subanalysis comparing cirrhotic liver (n=14) vs de novo (n=11) HCC was performed to identify confounding variables. Further evaluation focused on the 21 children with histologically confirmed HCC who underwent LR (n=7) vs LT (n=14). Kaplan-Meier survival curves were constructed.
Results: The mean age was 7.8 ± 6.1 years for patients with cirrhotic liver and 12.1 ± 3.5 years for de novo HCC. Our group observed overall total survival rates of 100%, 85% and 58% at 12, 36 and 60 months, respectively. De novo tumors had a higher recurrence rate and a poorer prognosis (P=.039 and P=.045). The disease-free survival at 60 months in our cohort was significantly lower among the LR group compared to the LT group (14% vs 82%; P=.0081). Recurrence after initial management (n=8) showed location differences between LR and LT. Preoperative alpha-fetoprotein (AFP) was elevated in 71% of children, but did not correlate with recurrence or compromised survival. Elevated AFP 3-months post-operation affected the course negatively (P=.044). Tumor number and diameter exhibited a trend towards poorer outcomes.
Conclusions: These findings emphasize the need for comprehensive pediatric surgical guidelines for HCC. We recommend LT over LR in pediatric cases. Extrahepatic disease post-neoadjuvant chemotherapy remains the only absolute contraindication.