Long-term Follow-up after Liver Resection in Children
Petrů O.1, Rygl M.1, Šnajdauf J.1, Čumlivská E.2, Mališ J.3, Tomášek L.4
Klinika dětské chirurgie 2. LF UK a FN Motol, subkatedra dětské chirurgie IPVZ, Praha1 přednosta prof. MUDr. J. Šnajdauf, DrSc. Klinika zobrazovacích metod 2. LF UK a FN Motol, Praha2 přednosta prof. MUDr. J. Neuwirth, CSc. Klinika dětské hematologie a onkologie 2. LF UK a FN Motol, Praha3 přednosta prof. MUDr. J. Starý, DrSc. Státní ústav radiační ochrany, Praha4 ředitel ing. R. Filgas |
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Summary:
Objective: To evaluate a general health of children after liver resection in a long-term horizon
since the operation. To evaluate their nutritional status, growth and further development. To evaluate
the ability of regeneration and continuous growth of liver parenchyma. To further evaluate
liver function, to evaluate liver functions in relation to the extent of resection, to oncological
therapy and to demonstrate independence of regeneration of liver parenchyma on the application
of chemotherapy; to evaluate cosmetic results in different periods of time after the surgery.
Material: A group of 30 children, who underwent liver resection in the period of 1991–2002.
Methods: The evaluation of present nutritional condition and assessment of evolution of nutritional
parameters by standard methods of measurement (weight, height, BMI, weight/height,
skinfold). The examination by computing tomography (CT) with special reference to liver parenchyma,
presence of regeneration nodes and, if any, relapse of the disease were observed. The
determination of regenerating capacity of the liver in individual periods of time according to the
index of liver regeneration (ratio of laterolateral (LL) distance of residual liver parenchyma and
the width of body trunk (T) at the given level) and its evolution and the determination of growth
continuity in a long period of time. The execution of biochemical, serological and hemocoagulation
analysis of blood samples were made for the determination of functional condition of liver
parenchyma. The evaluation of long-term cosmetic results after the surgery and their comparison
in groups was made according to type of suture.
The determination of correlations and statistical significance of individual observed parameters
in relation to the time from the operation, basic diagnosis (malignant, benign) or the application
of chemotherapy (CHT) and the extent of resection.
Results: At the present time 39 patients still live from those who underwent liver resection
during 1991–2002. Thirty patients (18 boys, 12 girls), whose parents agreed with their participation
in this study, were examined. The age of subjects in this group at the time of operation was in
the range of 0.5–14.5 years. The time period from the operation is from 1.5 to 13 years and the present
age of the patients in 2–23 years. The time since the end of chemotherapy is in the range of
2–13 years.
The comparison of average percentiles of individual anthropometric parameters of the observed
group with general population did not reveal statistically significant differences. The distribution
of patients into percentile ranges according to weight and height corresponded to distribution
of general population. The comparison of groups according the extent of resection, type of
basic disease and the time period from the surgery mostly did not reveal significant differences.
A favorable development of the nutritional condition in the long period of time after the operation
was detected in 87% of the patients. Chemotherapy did not influence nutritional development.
The values of dimensions obtained from CT documentation indicate that the index of liver
regeneration in postoperative period is growing at a maximum extent in the first years after the
resection. In the following years the liver parenchyma grows in relation to the growing width of
the body trunk. The measurements performed confirm a rapid volume regeneration of liver
parenchyma and the capacity of long-term growth after liver resection, even after the application
of oncological treatment with chemotherapy.
The proteosynthetic functions of the liver has been excellent in all patients. The metabolic and
excretory functions of the liver were within normal levels in more than 70% of patients, while the
others experienced only a mild elevation of individual liver tests (JT). None of the patients was
found to suffer from any complex of liver function disorder.
The cosmetic result (the appearance of the postoperative scar) of evaluated as excellent in
46.6% patients of the whole group, satisfactory in 26.7% of the patients and unsatisfactory in 26.7%
of the patients. The cosmetic results significantly improved (from 1994) after the introduction of
intradermal plastic stitch (an excellent effect in 73.8%, satisfactory in 15.7%, unsatisfactory only
in 10.5% of patients).
Key words:
liver resection in children, liver regeneration, nutritional status, liver function,
operation wound
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