Hepatic lobectomy in childhood: Effects of x-ray and chemotherapy

Abstract

Two patients who developed localized liver metastases 6 months and 3 years, respectively, after nephrectomy for Wilms' tumor were treated by right hepatic lobectomy. One child is alive without tumor 4 1 2 years after hepatic resection, and the other is alive but has developed peritoneal metastases at one year. Routine doses of actinomycin D and irradiation were administered postoperatively, but serious adverse reactions in the skin, bone marrow, and gastrointestinal tract were noted. Long-term postoperative evaluations reveal the development of severe chronic hepatic impairment due to inadequate liver regeneration and the effects of hepatic irradiation. Similar problems were not encountered in children with hepatic lesions treated only by hepatic lobectomy. In an experimental study, rats were subjected to 70 per cent hepatectomy and treated immediately with actinomycin D and/or irradiation to the liver. Death rates, body weight changes, and liver regeneration were compared to appropriate controls. Results confirm the impression that partial hepatectomy decreases tolerance to this drug and irradiation, and that these modalities in turn limit liver regeneration. These findings suggest that chemotherapy and irradiation be withheld following partial hepatectomy until liver regeneration is nearly complete.