Abstract
During the past 26 years (from Jannuary 1964 to April 1989, we had a surgical exprerience of 40 cases of primary liver malignancy in children under 16 years old : 26 hepato blastomas, 7 hepatocellular carcinomas, 4 mixed malignant tumors and 3 unknown histological malignacies. The mode of surgery and long term survivors more than 2 years (in the parentheses) were one left lateral segmentectomy with removal of two lymphnode metastases in the hepatoduodenal ligament ( 1 ) , 9 left lobectomies ( 3 ) , 3 extended left lobectomies including removal of the caudate lobe ( 0 ) , 3 right lobectomies ( 1 ) , 3 extended right lobectomies ( 0 ) , 9 rigth trisegmentectomies ( 6 ) , 2 extended rigth trisegmentectomies ( 1 ) , one partial resection for the recurrence ( 0 ) and 9 explorations ( 0 ) . Four died during surgery but no child died by complication. Socalled second look operation was carried out in 8. There are two long survivors : one unresectable case became resectable by VCR infusion through the hepatic artery and surviving 19 years, and one right trisegmentectomized case with tumor thrombus in the right portal branch in the first surgey underwent the resection of the lateral half of the remaining left laterral segment after recurrence, and remains disease-free 2.5 years after the second intervention. Our unique regimen and philosophy of preoperative and postoperative chemotherapy is as follows since 19 years : one intravenous shot of VCR of 1.5 mg/m^2 is given several days prior to surgery to know its effect to the neplasma utilysing the serum AFP value as a monitor. If the preoperative decrease of AFP value is not enongh, postoperative choice of drug is switched to ADR 20 mg/m^2, replacing VCR of 1.2 mg/m^2. Anyway the postoperative chemotharapy with VCR or ADR is given within 20 to 30 hours after surgery. No further chemotherapy was given in all cases. This timing is important, we believe, in order to kill the tumor cells disseminated during surgery and anchoring in other organs such as lung in the early postoperative period. Maybe by virtue of this regimen which is contrary to drastic pre and postoperative chemotherapy widely used recently, we have no pulmonary metasses since 19 years. Multiple recurrence in the remnant liver, which is not yet controlable even by the heavy chemotherapy, was the main cause of deeth. In cases of huge and unresectable tumor, however, the latest heavy chemotherapy may be indicated for possible shrinkage of the tumor that leads to the radical as well as easy removal of the tumor.
