Minimally-Invasive Liver Resection (MILR) in Pediatric Patients: Initial Experience and Outcomes

Purpose:

MILR is an established procedure in the adult population for benign and malignant conditions, offering less morbidity yet maintaining equivalent outcomes.  However, there lacks a published experience and familiarity in the pediatric population besides case reports of small isolated lesions. Our pediatric hepatobiliary experience now includes both open and MILR, and we hope to add insight into the role of MILR in pediatric patients.  This report describes our experience in pediatric MILR with respect to pathology, clinical details, and outcomes.

Methods:

Retrospective review of 38 pediatric patients (ages 9 months to 17 years) undergoing MILR for various conditions including benign (17) and malignant (21) lesions. MILR was performed by three techniques, pure laparoscopy (PL), hand-assisted laparoscopy (HA), and laparoscopic assisted (hybrid). Outcomes were reviewed including intra-operative outcomes, resection magnitude, complications, and recurrence.

Results:

The full spectrum of liver resection magnitude was achieved in both benign and malignant conditions. We noticed no difference in the magnitude of resection between benign and malignant conditions. 86% of cases were completed as pure laparoscopy. As expected, the operative time and blood loss correlated with the magnitude of resection (See Table 1.)

TABLE 1:  Resection Types

	Benign	Malig.	PL	HA/Hy	Time*	EBL*	Compls
Segmentectomy	3	8	10	1	74	20	2
Sectionectomy	1	4	5	-	125	54	-
Hemihepatectomy	11	9	16	4	222	81	3
Biliary resection	2	-	2	-	279	20	-

*Average in minutes and mL

Complications were minor and seen in 5 cases (seroma, port infection, port dehiscence, line infection, and hypertrophic scar), and there were no mortalities or re-operations. Oncologic outcomes were favorable (1/21 recurrence). Mean follow-up was 15.6 months.

Conclusion:   With careful patient selection, MILR can be performed safely in pediatric patients with good technical and oncologic outcome and low morbidity. Thereby adding to the surgical treatment algorithm for benign and malignant conditions.