Krishnakumar, G (2006) Outcome of Liver Resection in Children. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Liver tumors account for 1% of all childhood malignancies. Surgical resection forms the main stay of treatment of liver tumors. History has witnessed transition of liver surgery from the primitive techniques of amputation and excision in 1716 to the modern era of anatomic hepatic lobectomy in.1952. The evolution of hepatic resection, from an imprecise removal of portions of the liver, accompanied by extensive hemorrhage, to a controlled anatomic procedure with acceptable risk, represents a major advance in modern surgery. Appreciation of the segmental distribution of blood vessels and bile ducts within the liver, was an important landmark in liver resection, which brought about the anatomic liver resection in vogue. Improvements in surgical technique have brought about a sea of change in the perception of hepatic resection. Also, established long term survivals post resection have made a strong case for hepatic resection. Advances in life support, intensive care, anesthetic techniques, blood banking have contributed to the feasibility and safety of hepatic resection especially in neonates. Further, the recent developments in control of hepatic parenchymal bleeding such as laser, ultrasonic dissector, argon beam coagulator have improved the outcome of liver resection. At our Institute, we have a considerable burden of liver tumors, as the Institute with about 600 beds, housing all Paediatric Specialities, with availability of chemotherapy drugs, attracts referrals from allover the country. We have attempted to review our Institutional experience in the treatment of liver tumours. AIM : (i). To study the pattern of presentation of liver tumours in our Institute. (ii). To study the histopathological profile of liver tumours. (iii). To analyse the outcome of liver resection. MATERIALS AND METHODS : The study was a combined retrospective and prospective collection of children operated for liver lesions. Inclusion criteria for the study - all children who underwent liver resection were included in the study from January 1999 – January 2005. Exclusion criteria were cases not operated or liver resection done for causes other than neoplasms, like trauma. Informed consent was obtained from the parents of the children, for inclusion in the study. Cases that died or lost for follow up were identified. Otherwise, all cases were followed up on a periodic basis i.e - immediate post surgery every monthly till 1 yr, 3 monthly once for II yr, 6 monthly once for III yr, annually thereafter. Children underwent a complete clinical examination during the follow up visit. CONCLUSION : Annual burden of new liver tumors registered in our Institute is 1-2% of the total number of malignancies. Commonest liver tumor seen in our study is Hepatoblastoma, predominantly seen in age group less than 4 years. Anatomical liver resections preferable to non anatomical resections. Outcome of liver resection is good with 60% 2 yr survival rate. Further long term studies are required, to establish the role of neo adjuvant chemotherapy in liver tumors. Need to use vascular occlusion techniques, in the reduction of blood loss requires to be defined.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Liver Resection ; Outcome ; Children. |
| Subjects: | MEDICAL > Paediatric Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 28 Jul 2017 02:57 |
| Last Modified: | 28 Jul 2017 02:57 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2282 |
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