Is a modified central bisegmentectomy a volume-saving operation for pediatric hepatoblastoma?

The authors report on an 11-month-old girl who presented with a hepatoblastoma. The tumor was located in Couinaud's segments IV, V, VII, and VIII. She received adjuvant chemotherapy in accordance with the Japanese Study Group for Pediatric Liver Tumor Protocol-2, and the tumor thereafter showed a partial response, involving segments IV and VIII. She thereafter underwent a modified central bisegmentectomy (segments IV, VIII, and a part of V). The postoperative course was uneventful, and the patient is now doing well 22 months after the operation. The authors consider the central bisegmentectomy to be a volume-saving operation, and, based on a volumetric analysis, the estimated preserved volume of the functioning liver parenchyma was determined to be 87%. However, if using a right trisegmentectomy, the preserved volume was estimated to only be 44%. The authors consider a central bisegmentectomy to be a useful alternative operation for patients with centrally located hepatoblastoma to minimize both morbidity and mortality.