# Hepatoblastoma — GCMD Library living collection

Everything in the library about hepatoblastoma — built automatically from dossiers that name it.

Updated: n/a · 13 episodes · 270 cited statements

## Episodes
### Surgical Management
- [Hepatoblastoma: Update Course 2014](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648) — video · 24:43 · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648.md)
- [Hepatoblastoma: Update Course 2014](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882) — video · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882.md)
- [Indocyanine green is a sensitive adjunct in the identification and surgical management of local and metastatic hepatoblastoma](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416) — video · 1:04 · [machine version](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416.md)
- [Characteristics of Transfusion and Association With Oncologic Outcomes in Hepatoblastoma Resection](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811) — video · 1:10 · [machine version](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811.md)

### Complications
- [Early Postoperative Fever in Pediatric Oncology Patients Undergoing Solid Tumor Resection](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354) — video · 0:51 · [machine version](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354.md)

### Evidence & Research
- [BOB Ped Surg 2023 - Andrew Fleming, AAP  - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366) — video · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366.md)
- [Aggressive Pursuit of No Evidence of Disease Status in Hepatoblastoma Improves Survival](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771) — video · [machine version](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771.md)
- [Retreatment with Cisplatin May Provide a Survival Advantage for Children with Relapsed/Refractory Hepatoblastoma: An Institutional Experience](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394) — video · 1:10 · [machine version](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394.md)

### Case-Based Learning
- [Clinical & Research Update: Pediatric Liver Tumors -  A Case-Based Discussion with Drs. Katherine Somers & Alex Bondoc](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848) — video · 69:23 · [machine version](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848.md)

### In-Depth Reviews
- [Hepatoblastoma](https://library.globalcastmd.com/watch/hepatoblastoma-291) — podcast · 54:16 · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-291.md)
- [Hepatoblastoma with Dr. Greg Tiao](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960) — podcast · 10:12 · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960.md)
- [Hepatoblastoma with Dr. Greg Tiao](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256) — video · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256.md)

### Long-Term Care
- [Quality of Life Outcomes for Patients Who Underwent Conventional Resection and Liver Transplantation for Locally Advanced Hepatoblastoma](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423) — video · 1:05 · [machine version](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=0) Cisplatin Retreatment in Relapsed Hepatoblastoma (Ep 9)
- [0:00](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=0) ICG fluorescence imaging in hepatoblastoma surgery (Ep 10)
- [0:00](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=0) Quality of Life Outcomes in Hepatoblastoma Treatment (Ep 11)
- [0:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=0) Introduction and Study Context (Ep 12)
- [0:24](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=24) Study Findings (Ep 12)
- [0:51](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=51) Author Recommendations (Ep 12)
- [3:48](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=228) Case 1 Introduction and Imaging (Ep 13)
- [11:40](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=700) Case 1 Induction Therapy and Atypical Presentations (Ep 13)
- [20:06](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1206) Case 1 Surgical Management (Ep 13)
- [29:16](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1756) Case 1 Pathology and Adjuvant Therapy (Ep 13)
- [36:32](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2192) Case 2 Introduction and Complex Medical History (Ep 13)
- [47:49](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2869) Case 2 Modified Chemotherapy and Transplant Planning (Ep 13)
- [54:54](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3294) Case 2 Transplant Surgery and Pathology (Ep 13)
- [61:41](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3701) Molecular Diagnostics and Future Directions (Ep 13)
- [0:00](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=0) Early Postoperative Fever in Pediatric Oncology: Study Findings and Clinical Implications (Ep 8)
- [0:00](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=0) PRETEXT Staging System and Case Presentation (Ep 2)
- [3:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=232) Management Strategies and Chemotherapy Response (Ep 2)
- [12:08](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=728) Transplant Versus Extended Resection (Ep 2)
- [18:56](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1136) Surgical Decision-Making and Biopsy Practices (Ep 2)
- [24:49](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1489) Pulmonary Metastases and Future Research (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=0) Introduction and Differential Diagnosis (Ep 5)
- [2:20](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=140) Clinical Presentation and Diagnostic Workup (Ep 5)
- [4:25](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=265) Liver Anatomy and Pre-text Staging (Ep 5)
- [8:01](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=481) Treatment Algorithms and Outcomes (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=0) Introduction and Background on Hepatoblastoma (Ep 6)
- [2:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=120) Study Rationale and Methods (Ep 6)
- [4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=240) Results: Patient Cohort and Pulmonary Metastasectomy (Ep 6)
- [6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=360) Survival Analysis and Conclusions (Ep 6)
- [0:00](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=0) Study Overview and Key Findings (Ep 7)
- [0:00](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=0) Introduction and Initial Presentation (Ep 3)
- [1:37](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=97) Differential Diagnosis and Initial Workup (Ep 3)
- [6:50](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=410) PRETEXT Staging and Resectability Assessment (Ep 3)
- [11:45](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=705) PRETEXT System Details and Annotation Factors (Ep 3)
- [19:30](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1170) Pure Fetal Histology and Treatment Pathways (Ep 3)
- [25:35](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1535) Unresectable Disease and Referral Timing (Ep 3)
- [28:50](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1730) Risk Stratification and Pulmonary Metastases (Ep 3)
- [33:41](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2021) Surgical Technique and Intraoperative Management (Ep 3)
- [42:05](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2525) Extreme Resection versus Transplantation (Ep 3)
- [46:19](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2779) Recurrence Management and Summary (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=0) PRETEXT and POSTTEXT staging systems for hepatoblastoma (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "There is no established standard salvage therapy regimen for relapsed hepatoblastoma" — Sophia Schermerhorn (guideline) [Ep 9 · 0:12](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=12)
- "The Cincinnati Children's retrospective review of 30 patients represents one of the largest published cohorts evaluating patients with refractory or recurrent hepatoblastoma" — Sophia Schermerhorn (epidemiological) [Ep 9 · 0:17](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=17)
- "The overall survival for the cohort was about 50%" — Sophia Schermerhorn (clinical) [Ep 9 · 0:25](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=25)
- "Children who received cisplatin as part of their salvage therapy had survival of about 80% compared to 25% for those who did not receive cisplatin" — Sophia Schermerhorn (clinical) [Ep 9 · 0:28](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=28)
- "The improved survival outcomes with cisplatin may be due to persistent platinum sensitivity or better tumor biology rather than proving causality" — Sophia Schermerhorn (opinion) [Ep 9 · 0:36](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=36)
- "Most patients underwent additional surgery as part of their salvage therapy, either liver resection, liver transplant, or pulmonary metastasectomy" — Sophia Schermerhorn (clinical) [Ep 9 · 0:49](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=49)
- "Salvage therapy for relapsed hepatoblastoma is multimodal" — Sophia Schermerhorn (clinical) [Ep 9 · 0:57](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=57)
- "Cisplatin retreatment should be balanced with the risk of cumulative toxicity" — Sophia Schermerhorn (opinion) [Ep 9 · 0:59](https://library.globalcastmd.com/watch/retreatment-with-cisplatin-may-provide-a-survival-advantage-for-children-with-relapsed-refractory-hepatoblastoma-an-institutional-experience-11394?t=59)
- "This is a single institution retrospective review of patients who received ICG prior to either pulmonary metastatectomy or liver resection for hepatoblastoma" — Sophia Schermerhorn (clinical) [Ep 10 · 0:12](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=12)
- "ICG was highly sensitive for detecting hepatoblastoma, about 90%" — Sophia Schermerhorn (clinical) [Ep 10 · 0:22](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=22)
- "In a meaningful number of cases, ICG was able to detect tumor deposits that were not visible, palpable, or detectable on preoperative imaging" — Sophia Schermerhorn (clinical) [Ep 10 · 0:27](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=27)
- "Specificity was lower than sensitivity with false positives" — Sophia Schermerhorn (clinical) [Ep 10 · 0:39](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=39)
- "False positives often represented vascular changes or inflammation" — Sophia Schermerhorn (clinical) [Ep 10 · 0:43](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=43)
- "There were no adverse outcomes associated with any of the additional resections guided by ICG" — Sophia Schermerhorn (clinical) [Ep 10 · 0:46](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=46)
- "ICG was effective in both open and minimally invasive surgery" — Sophia Schermerhorn (clinical) [Ep 10 · 0:50](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=50)
- "ICG was effective in both relapse and primary disease" — Sophia Schermerhorn (clinical) [Ep 10 · 0:50](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=50)
- "This is a single institution cross-sectional study using validated pediatric quality of life surveys to evaluate long-term survivors of hepatoblastoma." — Sophia Schermerhorn (clinical) [Ep 11 · 0:24](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=24)
- "Survival for hepatoblastoma continues to improve." — Sophia Schermerhorn (epidemiological) [Ep 11 · 0:18](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=18)
- "Long-term quality of life is becoming a more important outcome as hepatoblastoma survival improves." — Sophia Schermerhorn (opinion) [Ep 11 · 0:18](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=18)
- "Overall quality of life outcomes were similar between liver transplant and resection groups for hepatoblastoma." — Sophia Schermerhorn (clinical) [Ep 11 · 0:31](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=31)
- "There was no significant difference in emotional, social, physical, or school functioning outcomes between transplant and resection groups." — Sophia Schermerhorn (clinical) [Ep 11 · 0:31](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=31)
- "Patients who underwent resection had lower overall procedure anxiety scores than transplant patients." — Sophia Schermerhorn (clinical) [Ep 11 · 0:47](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=47)
- "The finding of lower procedural anxiety in resection patients was mirrored in the parents' surveys." — Sophia Schermerhorn (clinical) [Ep 11 · 0:53](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=53)
- "Long-term quality of life outcomes appear comparable between patients who undergo resection and liver transplantation for hepatoblastoma." — Sophia Schermerhorn (clinical) [Ep 11 · 0:55](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=55)
- "Surgical strategy for hepatoblastoma can be focused on oncologic control given comparable quality of life outcomes." — Sophia Schermerhorn (opinion) [Ep 11 · 1:02](https://library.globalcastmd.com/watch/quality-of-life-outcomes-for-patients-who-underwent-conventional-resection-and-liver-transplantation-for-locally-advanced-hepatoblastoma-11423?t=62)
- "It is not uncommon for a patient with hepatoblastoma to need a transfusion during resection" — Jill Knepprath (clinical) [Ep 12 · 0:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=0)
- "The study was multi-institutional and published in Pediatric Blood and Cancer in 2025" — Jill Knepprath (epidemiological) [Ep 12 · 0:13](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=13)
- "The study examined how intraoperative transfusion may affect recurrence and survival in hepatoblastoma resection patients" — Jill Knepprath (epidemiological) [Ep 12 · 0:19](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=19)
- "Of those transfused, the majority received red blood cells" — Jill Knepprath (epidemiological) [Ep 12 · 0:25](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=25)
- "Only 11% of transfused patients received platelets" — Jill Knepprath (epidemiological) [Ep 12 · 0:25](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=25)
- "Intraoperative blood transfusions had no effect on recurrence" — Jill Knepprath (clinical) [Ep 12 · 0:32](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=32)
- "Intraoperative blood transfusions were associated with increased death" — Jill Knepprath (clinical) [Ep 12 · 0:32](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=32)
- "There were instances of unnecessary blood transfusions" — Jill Knepprath (clinical) [Ep 12 · 0:39](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=39)
- "Patients who were transfused had higher post-op hemoglobin" — Jill Knepprath (clinical) [Ep 12 · 0:43](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=43)
- "Transfused patients still required more plasma and platelets postoperatively" — Jill Knepprath (clinical) [Ep 12 · 0:43](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=43)
- "The authors think that blood transfusions were mostly red blood cells, and that is what contributed to the post-op coagulopathy" — Jill Knepprath (opinion) [Ep 12 · 0:52](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=52)
- "The authors recommend more careful patient selection for intraoperative transfusions" — Jill Knepprath (guideline) [Ep 12 · 1:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=60)
- "The authors recommend a balanced transfusion approach" — Jill Knepprath (guideline) [Ep 12 · 1:00](https://library.globalcastmd.com/watch/characteristics-of-transfusion-and-association-with-oncologic-outcomes-in-hepatoblastoma-resection-11811?t=60)
- "Rib fractures or vertebral fractures are fairly common as a presentation factor with hepatic tumors in young children, particularly hepatoblastoma" — Katherine Somers (clinical) [Ep 13 · 14:51](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=891)
- "Fractures will heal as children go through their therapy, and kids are remarkable in their resilience and tend to be rather unbothered by their fractures once cancer therapy is underway" — Katherine Somers (clinical) [Ep 13 · 15:29](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=929)
- "Precocious puberty in a Tanner stage one patient is a sign that should prompt consideration of underlying malignancy on the differential" — Katherine Somers (clinical) [Ep 13 · 15:43](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=943)
- "MRI using a hepatobiliary contrast agent is the first-line imaging study for patients with a liver tumor, allowing better visualization of multifocal disease and ideal assessment of hepatic vasculature" — Alex Tobin (guideline) [Ep 13 · 7:51](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=471)
- "PRETEXT criteria define metastatic disease as more than 2 nodules greater than 3 millimeters in diameter or 1 nodule greater than 5 millimeters in diameter" — Alex Tobin (guideline) [Ep 13 · 38:39](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2319)
- "High-risk therapy for hepatoblastoma includes cisplatin and doxorubicin, with dexrazoxane cardiac protectant given institutionally with doxorubicin" — Katherine Somers (clinical) [Ep 13 · 18:38](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1118)
- "Weight loss or sarcopenia during active cancer therapy is associated with poor outcomes across all pediatric cancer diagnoses" — Katherine Somers (epidemiological) [Ep 13 · 19:39](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1179)
- "Almost every young toddler with a large liver tumor requires aggressive nutritional support to get through intensive therapy and surgical procedures" — Katherine Somers (clinical) [Ep 13 · 19:18](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1158)
- "Maximum tumor shrinkage typically occurs after the first block or cycle of chemotherapy; subsequent blocks produce less shrinkage" — Alex Bondoc (clinical) [Ep 13 · 24:34](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1474)
- "ICG fluorescence is highly sensitive but not specific for tumor detection; it can help find multifocal disease and assess margins" — Alex Bondoc (clinical) [Ep 13 · 26:05](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1565)
- "In approximately 15% of lung resections, ICG fluorescence identifies lesions not visible on high-resolution axial imaging" — Alex Bondoc (clinical) [Ep 13 · 26:21](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1581)
- "The FIT trial (AHEP 1531) mandated liver biopsy for diagnosis before starting treatment" — Ranga (Ranganathan) (guideline) [Ep 13 · 30:05](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1805)
- "Post-chemotherapy tumor response is maximum in initial stages; once tumor is replaced by blood pools and fibrous tissue, size doesn't decrease much further" — Ranga (Ranganathan) (clinical) [Ep 13 · 33:04](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1984)
- "Even when first-side chest metastases show no viable tumor, the other side is still cleared surgically because combined chemotherapy and surgical clearance is the best pathway to cure" — Katherine Somers (guideline) [Ep 13 · 39:20](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2360)
- "Patients with hepatoblastoma are frequently born prematurely" — Alex Tobin (epidemiological) [Ep 13 · 45:07](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2707)
- "End-stage renal disease early in life shows increased incidence of hepatoblastoma, not just autosomal recessive polycystic kidney disease" — Katherine Somers (epidemiological) [Ep 13 · 49:18](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2958)
- "Cisplatin's primary toxicity is renal, and platinum excretion is fully dependent on a functioning renal system" — Katherine Somers (clinical) [Ep 13 · 49:39](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=2979)
- "Patients on peritoneal dialysis can receive platinum chemotherapy using advanced pharmacokinetic and pharmacodynamic modeling without typical mandated hyperhydration" — Katherine Somers (clinical) [Ep 13 · 50:02](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3002)
- "For known predisposition patients, screening protocol starts with ultrasound and alpha-fetoprotein levels, accounting for different normal AFP ranges in first months of life" — Katherine Somers (guideline) [Ep 13 · 51:20](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3080)
- "PRETEXT IV multifocal disease requires liver transplantation; patients should be referred early to transplant program" — Alex Bondoc (guideline) [Ep 13 · 52:15](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3135)
- "In the United States, children with hepatoblastoma automatically receive Status 1B categorization on deceased donor list, the second highest stratum for organ allocation" — Alex Bondoc (guideline) [Ep 13 · 59:46](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3586)
- "Conventional hepatoblastoma is genomically quiet with very low mutation burden and invariably has point mutation or small deletion in exon 3 of CTNNB1 gene" — Ranga (Ranganathan) (clinical) [Ep 13 · 62:23](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3743)
- "Hepatocellular neoplasm NOS shows more genomic instability with chromosomal gains and losses, characterized by CTNNB1 deletion, often large deletions or complete exon 3 skipping" — Ranga (Ranganathan) (clinical) [Ep 13 · 62:41](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3761)
- "Beta-catenin immunohistochemistry is frequently weak positive or negative in HCC-NOS, serving as a diagnostic clue along with pleomorphic appearance and macrotrabecular arrangement" — Ranga (Ranganathan) (clinical) [Ep 13 · 63:19](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3799)
- "HCC-NOS can be targeted with high-risk hepatoblastoma therapy to shrink tumors and make them amenable to surgery in most cases" — Ranga (Ranganathan) (clinical) [Ep 13 · 63:51](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3831)
- "Every child with new cancer diagnosis meets with genetic counseling oncology team for complete genetic testing including germline testing if something is identified" — Katherine Somers (guideline) [Ep 13 · 65:03](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3903)
- "Radiomics can predict pure fetal histology hepatoblastoma with area under ROC curve of approximately 0.85" — Alex Tobin (clinical) [Ep 13 · 66:36](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=3996)
- "Pure fetal histology hepatoblastoma patients are cured with resection alone and don't need chemotherapy" — Alex Tobin (clinical) [Ep 13 · 66:58](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=4018)
- "Artificial intelligence can segment liver tumors very accurately at the level of an expert" — Alex Tobin (clinical) [Ep 13 · 67:13](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=4033)
- "Tumor board presentation and multidisciplinary conference approach is associated with improved success and long-term outcomes for pediatric liver tumor patients" — Alex Bondoc (epidemiological) [Ep 13 · 23:04](https://library.globalcastmd.com/watch/clinical-research-update-pediatric-liver-tumors-a-case-based-discussion-with-drs-katherine-somers-alex-bondoc-11848?t=1384)
- "42% of 220 oncology patients had a fever in the 48 hours following tumor resection" — Sophia Schermerhorn (epidemiological) [Ep 8 · 0:12](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=12)
- "Only 2 of the febrile patients (2.8%) had an actual infection" — Sophia Schermerhorn (epidemiological) [Ep 8 · 0:19](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=19)
- "The two patients with actual infection were hemodynamically unstable with positive blood cultures" — Sophia Schermerhorn (clinical) [Ep 8 · 0:19](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=19)
- "Most fevers triggered a workup that costs on average about $500 per patient" — Sophia Schermerhorn (epidemiological) [Ep 8 · 0:30](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=30)
- "About a third of patients received empiric antibiotics that they did not need" — Sophia Schermerhorn (epidemiological) [Ep 8 · 0:30](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=30)
- "In the 48 hours following tumor resection, fever alone may not be a reason to panic" — Sophia Schermerhorn (opinion) [Ep 8 · 0:40](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=40)
- "Extensive workup should be reserved for patients who are hemodynamically unstable or have more overt signs of infection" — Sophia Schermerhorn (guideline) [Ep 8 · 0:45](https://library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=45)
- "PRETEXT staging stands for pretreatment extent of disease and is based on segmental liver anatomy prior to chemotherapy" (clinical) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- "PRETEXT staging has a tendency to overstage because it is based purely on imaging and bulky tumors make it hard to assess true vascular invasion versus mass effect" (clinical) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- "POSTTEXT refers to extensive disease after neoadjuvant chemotherapy has been given" (clinical) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=101)
- "Key staging annotations include involvement of the retrohepatic cava or hepatic veins and the portal vein bifurcation" (clinical) [Ep 2 · 3:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=232)
- "COG recommendations state that PRETEXT stage 2 tumors with no vascular involvement and achievable 1 cm margin can be resected upfront without neoadjuvant chemotherapy" (guideline) [Ep 2 · 7:30](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=450)
- "COG feels that PRETEXT stage 1 and 2 tumors do not necessarily need referral to centers with liver resection expertise if the local surgeon feels competent" (guideline) [Ep 2 · 7:55](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=475)
- "Most tumor shrinkage from chemotherapy occurs within the first two cycles" (clinical) [Ep 2 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- "Current recommendations are that after two cycles of chemotherapy, if the tumor has not shrunk to a resectable point, the patient should be evaluated for transplant" (guideline) [Ep 2 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- "As hepatoblastoma tumors shrink with chemotherapy, they do not shrink away from the vascular supply, so chemotherapy does not improve vascular margins" (clinical) [Ep 2 · 10:26](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=626)
- "The goal surgical margin for hepatoblastoma resection is 1 cm" (clinical) [Ep 2 · 12:08](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=728)
- "Survival in patients undergoing extended or heroic resections (tumor liver explants with back table resection and reimplant, portal vein reconstructions, hepatic vein reconstructions) is not as good as transplant survival" (clinical) [Ep 2 · 12:33](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=753)
- "There has been a move away from heroic resections for hepatoblastoma" (opinion) [Ep 2 · 12:33](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=753)
- "Patients who undergo failed resection followed by rescue transplant have worse survival than patients who undergo planned transplant upfront" (clinical) [Ep 2 · 14:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=892)
- "Patients should be referred to a transplant center early even if they may not ultimately need transplant, to have pre-transplant evaluation completed and be plugged into the system" (guideline) [Ep 2 · 15:48](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=948)
- "Primary transplant patients with hepatoblastoma do surprisingly well despite immunosuppression against rejection in the setting of cancer" (clinical) [Ep 2 · 16:38](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=998)
- "For non-transplant center surgeons, criteria for proceeding with resection include feeling 95% confident of success and ability to perform an anatomic resection with good margin" (opinion) [Ep 2 · 18:56](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1136)
- "Disease close to hepatic veins, disease extending across the liver, or involvement of the portal vein should prompt referral to a transplant center" (opinion) [Ep 2 · 19:54](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1194)
- "The truth about resectability is determined at the time of operation despite all available imaging" (opinion) [Ep 2 · 21:52](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1312)
- "In Europe, all liver tumors receive chemotherapy upfront before surgery because it results in smaller, easier-to-resect tumors" (clinical) [Ep 2 · 22:13](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1333)
- "Core needle biopsy for hepatoblastoma typically requires about 10 passes through an area that includes normal parenchyma and tumor" (clinical) [Ep 2 · 23:53](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1433)
- "There are two camps regarding pulmonary metastasis treatment: one advocates resecting metastases upfront before hepatectomy, the other suggests waiting until after hepatectomy because liver regeneration growth factors may stimulate previously unrecognized lung sites" (clinical) [Ep 2 · 24:49](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1489)
- "There is no good data on either side of the pulmonary metastasis timing debate, with both approaches limited to a handful of patients" (opinion) [Ep 2 · 24:49](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1489)
- "Papers on stage IV hepatoblastoma with lung metastases are limited to cohorts of less than 20 patients, making it hard to draw good conclusions" (epidemiological) [Ep 2 · 26:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1571)
- "There may be reporting bias in transplant outcomes because successes are reported but not all failures" (opinion) [Ep 2 · 26:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-882?t=1571)
- "Hepatoblastoma is the most common malignant liver tumor in the pediatric population" (epidemiological) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=0)
- "There are around 250 new cases of hepatoblastoma per year" (epidemiological) [Ep 5 · 0:20](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=20)
- "Treatment strategies for hepatoblastoma have changed dramatically over the past 25 years" (clinical) [Ep 5 · 0:10](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=10)
- "Hepatoblastoma is nowhere near the most common liver tumor or the most common abdominal tumor in children" — Greg Tiao (epidemiological) [Ep 5 · 0:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=46)
- "Neuroblastoma is the most common solid malignancy in the pediatric population" (epidemiological) [Ep 5 · 1:14](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=74)
- "Hemangioma is the most common liver lesion in children" (epidemiological) [Ep 5 · 1:40](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=100)
- "Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, or respiratory distress due to tumor size" — Greg Tiao (clinical) [Ep 5 · 2:20](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=140)
- "Hepatoblastoma can present as a paraneoplastic syndrome like precocious puberty" (clinical) [Ep 5 · 2:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166)
- "An elevated alpha fetoprotein (AFP) is a key component in the workup and is critical for the diagnostic algorithm and treatment response" (clinical) [Ep 5 · 2:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166)
- "Most experts rely on MRI to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma" — Greg Tiao (clinical) [Ep 5 · 3:13](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193)
- "Eovist is an MRI contrast agent taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging" — Greg Tiao (clinical) [Ep 5 · 3:13](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193)
- "To establish a diagnosis of hepatoblastoma, four things are needed: history, abdominal imaging, AFP check, and liver biopsy" (clinical) [Ep 5 · 3:39](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219)
- "The most important intervention for survival is to achieve complete resection" (clinical) [Ep 5 · 3:39](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219)
- "Aggressive resections include trisectionectomy, mesohepatectomy, resection with additional procedure in remnant liver, and liver transplantation" — Greg Tiao (clinical) [Ep 5 · 4:25](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=265)
- "Couinaud labeled liver segments in a counterclockwise fashion by injecting portal vessels, similar to how districts of Paris are labeled" (clinical) [Ep 5 · 4:50](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=290)
- "The right hepatic vein differentiates anterior and posterior sections of the right liver" — Greg Tiao (clinical) [Ep 5 · 5:41](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=341)
- "The right portal vein separates superior and inferior segments of the right liver" — Greg Tiao (clinical) [Ep 5 · 6:02](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=362)
- "The pre-text staging system classifies tumors based on the number of contiguous liver sections free of disease (minus four equals pre-text stage)" — Greg Tiao (clinical) [Ep 5 · 6:51](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411)
- "Pre-text 1 has three contiguous sections free of disease, pre-text 2 has two, pre-text 3 has one, and pre-text 4 has no free sections or diffuse tumor" — Greg Tiao (clinical) [Ep 5 · 6:51](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411)
- "Pre-text 1 and 2 tumors with greater than 1 cm margin from middle hepatic vein and portal bifurcation should be considered for resection at diagnosis" (clinical) [Ep 5 · 8:01](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=481)
- "Pre-text 3 and 4 tumors represent a big game changer in practice that improved survival from less than 30% in the 1970s-80s to 80-90% today" — Greg Tiao (clinical) [Ep 5 · 8:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495)
- "Pre-text 3 tumors should generally be biopsied at diagnosis, started on neoadjuvant chemotherapy, then referred to transplant center or center with expertise in advanced liver resections" — Greg Tiao (clinical) [Ep 5 · 8:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495)
- "Indications for transplant in pre-text 3 or 4 disease include unresectable disease, unsafe resection, or inadequate liver remnant" (clinical) [Ep 5 · 9:12](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=552)
- "It is important to consult a transplant center early for pre-text 3 and 4 tumors" — Greg Tiao (clinical) [Ep 5 · 9:35](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=575)
- "The PHITT (Pediatric Hepatic International Tumor Trial) is an ongoing multinational trial to identify high and low risk features for each pre-text stage" — Greg Tiao (clinical) [Ep 5 · 10:27](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627)
- "The PHITT study has been ongoing for three years" — Greg Tiao (clinical) [Ep 5 · 10:27](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627)
- "Hepatoblastoma is the most common pediatric liver cancer" — Andrew Fleming (epidemiological) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=0)
- "The number of contiguous hepatic sections uninvolved by tumor can be used radiographically to determine the pre-treatment extent of disease, making the PRETEXT group" — Andrew Fleming (clinical) [Ep 6 · 0:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=30)
- "PRETEXT group in combination with presence/absence of metastatic disease, alpha fetoprotein at diagnosis, PRETEXT modifiers, patient age and resectability at diagnosis can be used to risk stratify patients according to the AHEAD 1531 clinical trial" — Andrew Fleming (guideline) [Ep 6 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=60)
- "Complete surgical resection has been determined to be necessary for patient survival" — Andrew Fleming (clinical) [Ep 6 · 1:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=90)
- "Cisplatin based chemotherapies have improved rates of resectability and subsequently survival for hepatoblastoma patients" — Andrew Fleming (clinical) [Ep 6 · 1:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=105)
- "The reported survival benefits of pulmonary metastasectomy for hepatoblastoma have varied in the literature" — Andrew Fleming (epidemiological) [Ep 6 · 2:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=120)
- "No evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging" — Andrew Fleming (clinical) [Ep 6 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=180)
- "Among 50 patients included for analysis, 24 were determined to be high risk" — Andrew Fleming (epidemiological) [Ep 6 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=240)
- "All patients received chemotherapy and 41 patients were successfully able to be rendered no evidence of disease status" — Andrew Fleming (clinical) [Ep 6 · 4:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=255)
- "14 patients underwent a total of 31 pulmonary procedures, having a median of four nodules resected per patient" — Andrew Fleming (clinical) [Ep 6 · 4:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=270)
- "Median of three nodules per patient contained pathologically confirmed viable hepatoblastoma, confirming a high degree of concordance between radiographic evidence of disease and pathological confirmation of disease" — Andrew Fleming (clinical) [Ep 6 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=300)
- "On logistic regression for three-year mortality, only achieving no evidence of disease was associated with a significant decrease in patient mortality" — Andrew Fleming (clinical) [Ep 6 · 5:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=330)
- "The overall survival of the entire cohort is quite high" — Andrew Fleming (clinical) [Ep 6 · 6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=360)
- "The event-free survival is lower than overall survival due to relapse events after achieving no evidence of disease" — Andrew Fleming (clinical) [Ep 6 · 6:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=375)
- "The overall survival and event-free survival of the group in whom we were unable to render them no evidence of disease is significantly lower, with no patients in these cohorts surviving past two years" — Andrew Fleming (clinical) [Ep 6 · 6:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=390)
- "The overall survival is similar between high risk and not high risk patients who were able to be rendered no evidence of disease status" — Andrew Fleming (clinical) [Ep 6 · 7:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=420)
- "The event-free survival remains significantly lower for the high-risk no evidence of disease group due to five high-risk patients who relapsed" — Andrew Fleming (clinical) [Ep 6 · 7:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=435)
- "Three of five high-risk patients who relapsed were successfully salvaged using a combination of chemotherapy and further pulmonary resections" — Andrew Fleming (clinical) [Ep 6 · 7:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=450)
- "No evidence of disease status is necessary for survival in patients with hepatoblastoma" — Andrew Fleming (clinical) [Ep 6 · 7:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=465)
- "Repeated pulmonary metastasectomy and/or complex local control strategies to obtain no evidence of disease benefit high risk patients" — Andrew Fleming (clinical) [Ep 6 · 7:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=465)
- "The study was a retrospective observational study conducted at Cincinnati Children's Hospital from 2005 to 2021" — Cecilia Gigena (clinical) [Ep 7 · 0:00](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=0)
- "The study aim was to examine the effect of aggressive pursuit of no evidence of disease status on overall survival and event free status" — Cecilia Gigena (clinical) [Ep 7 · 0:20](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=20)
- "The study included 50 patients with hepatoblastoma" — Cecilia Gigena (epidemiological) [Ep 7 · 0:35](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=35)
- "41 patients were rendered to no evidence of disease status" — Cecilia Gigena (clinical) [Ep 7 · 0:42](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=42)
- "Overall survival and event free status were significantly improved in both high risk and non-high risk patients who achieved no evidence of disease status" — Cecilia Gigena (clinical) [Ep 7 · 0:48](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=48)
- "Pursuing no evidence of disease status is better for overall survival in hepatoblastoma patients" — Cecilia Gigena (opinion) [Ep 7 · 0:58](https://library.globalcastmd.com/watch/aggressive-pursuit-of-no-evidence-of-disease-status-in-hepatoblastoma-improves-survival-6771?t=58)
- "Liver tumors are rare in children, and sorting out the diagnosis is crucial for good outcomes." — Max Langham (clinical) [Ep 3 · 1:37](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=97)
- "A one-year-old with a liver mass is likely to be hepatoblastoma, although rhabdoid tumor can occur at that age and is a bad actor." — Max Langham (clinical) [Ep 3 · 1:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=113)
- "If alpha-fetoprotein is quite high and very elevated, the presumptive diagnosis in a 1-year-old would be hepatoblastoma." — Max Langham (clinical) [Ep 3 · 2:06](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=126)
- "Hepatoblastoma presents from the first year of life through perhaps 10 years of age, although there are a few that have been diagnosed older than that." — Max Langham (epidemiological) [Ep 3 · 2:19](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=139)
- "If this is a rhabdoid tumor, chemotherapy is not important and the lesion needs to be resected." — Max Langham (clinical) [Ep 3 · 2:43](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=163)
- "If it's a very low risk hepatoblastoma, it probably doesn't need a biopsy and needs an upfront resection." — Max Langham (clinical) [Ep 3 · 2:55](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=175)
- "Most people favor needle biopsy of the liver rather than an open biopsy or a laparoscopic biopsy." — Max Langham (clinical) [Ep 3 · 3:40](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=220)
- "The biopsy should go through the normal part of the liver that will be resected with the specimen, approaching from the side of the tumor to avoid seeding the contralateral lobe." — Max Langham (clinical) [Ep 3 · 3:51](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=231)
- "Hepatoblastoma will seed and can create big issues for future resection and cure if the biopsy crosses the uninvolved lobe." — Max Langham (clinical) [Ep 3 · 4:06](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=246)
- "There have been prenatal diagnoses of hepatoblastoma, not super rare but not very common." — Max Langham (epidemiological) [Ep 3 · 4:46](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=286)
- "Rhabdoid tumor is more common in very young children compared to hepatoblastoma." — Max Langham (epidemiological) [Ep 3 · 4:57](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=297)
- "Hepatocellular carcinoma can occur in young children, usually in association with an inborn error of metabolism, with tyrosinemia as the prototype." — Max Langham (clinical) [Ep 3 · 5:29](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=329)
- "A baby with tyrosinemia will develop hepatocellular carcinoma if they are not transplanted, usually in the first couple of years of life." — Max Langham (clinical) [Ep 3 · 5:40](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=340)
- "There is a mixed tumor with features of hepatoblastoma and hepatocellular carcinoma that tends to occur in children over 6 years of age." — Max Langham (clinical) [Ep 3 · 5:50](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=350)
- "There is a predisposition of premature infants to getting hepatoblastomas, usually not in the nursery but in the first year or two of life." — Max Langham (epidemiological) [Ep 3 · 7:40](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=460)
- "For the biology arm of the Children's Oncology Group, they want 10 core biopsies." — Max Langham (guideline) [Ep 3 · 8:52](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=532)
- "The complication rate and some mortality seems higher with open biopsies than with the needle technique." — Max Langham (clinical) [Ep 3 · 9:16](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=556)
- "There is no role for frozen section in hepatoblastoma, either for initial biopsy or for later margin assessment." — Max Langham (clinical) [Ep 3 · 9:57](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=597)
- "The overarching goal of treatment for hepatoblastoma is to get the kids to a safe resection." — Max Langham (clinical) [Ep 3 · 10:27](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=627)
- "The PRETEXT system is a pre-treatment extent of disease radiographic imaging-based system developed in Europe during SIOPEL 1." — Max Langham (clinical) [Ep 3 · 10:46](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=646)
- "Couinaud based the numerology of liver segments on the street map of Paris, with the caudate lobe (segment 1) representing the Île de Paris where Notre Dame is located." — Max Langham (clinical) [Ep 3 · 12:13](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=733)
- "A PRETEXT 1 lesion has three contiguous sectors of the liver that are free of tumor." — Max Langham (clinical) [Ep 3 · 12:50](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=770)
- "A PRETEXT 2 lesion has two adjoining sectors free of tumor." — Max Langham (clinical) [Ep 3 · 13:17](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=797)
- "With PRETEXT 3, there is only one sector free of disease." — Max Langham (clinical) [Ep 3 · 13:42](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=822)
- "In PRETEXT 4, all of the sectors are involved with no sectors of the liver free of disease." — Max Langham (clinical) [Ep 3 · 14:00](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=840)
- "It is more common for people to over-read PRETEXT than under-read it." — Max Langham (clinical) [Ep 3 · 14:17](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=857)
- "In AHEP 0731 and the FIT trial, upfront resection is acceptable if it is a conventional hemihepatectomy or less, with clearly 1 centimeter of normal liver between the middle hepatic vein and tumor, and no annotation factors." — Max Langham (guideline) [Ep 3 · 14:43](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=883)
- "If a lesion is resected upfront and histology shows well-differentiated pure fetal histology, the baby is done with no need for any chemotherapy at all, and survival is 100%." — Max Langham (clinical) [Ep 3 · 15:37](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=937)
- "Along with imaging for suspected hepatoblastoma, a chest CT is needed because pulmonary metastases make up the vast majority of metastases, and even small liver tumors can metastasize." — Max Langham (clinical) [Ep 3 · 16:52](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1012)
- "If there is a PRETEXT 1 lesion with metastatic disease in the lungs, that is a high-risk patient." — Max Langham (clinical) [Ep 3 · 17:21](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1041)
- "For a PRETEXT 1 lesion with clear lungs, no vena cava, hepatic vein confluence, or portal vein involvement, and judged resectable by the surgeon, it should be resected with an anatomic resection and the child will be in a very low risk group." — Max Langham (clinical) [Ep 3 · 17:31](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1051)
- "A PRETEXT 1 lesion with vascular involvement (within 1 cm of cava or hepatic veins) would be considered an intermediate risk patient." — Max Langham (clinical) [Ep 3 · 18:44](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1124)
- "If a patient with hepatoblastoma is over 8 years of age, that moves the patient into a higher risk environment." — Max Langham (clinical) [Ep 3 · 18:59](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1139)
- "Not all PRETEXT 1 lesions are resectable upfront, and there are some PRETEXT 2 lesions that are resectable upfront." — Max Langham (clinical) [Ep 3 · 19:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1193)
- "Annotation factors include V for vena cava and hepatic veins; if they are more than 1 centimeter away from the vena cava, there is no annotation factor." — Max Langham (clinical) [Ep 3 · 20:14](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1214)
- "V0 means the lesion is within 1 centimeter of the cava or confluence of hepatic veins, making the patient no longer eligible for upfront resection." — Max Langham (clinical) [Ep 3 · 20:35](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1235)
- "V1 means the tumor is abutting either the vena cava or the three hepatic veins." — Max Langham (clinical) [Ep 3 · 20:48](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1248)
- "V2 means the tumor is large enough that it is distorting or pushing the vessels away." — Max Langham (clinical) [Ep 3 · 20:56](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1256)
- "V3 means there is evidence of tumor thrombus extending out of the vein, which is particularly problematic." — Max Langham (clinical) [Ep 3 · 21:00](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1260)
- "Hepatoblastoma is like Wilms tumor in that you can get direct extension of large tumor thrombus out of the hepatic veins into the vena cava and even up into the heart." — Max Langham (clinical) [Ep 3 · 21:09](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1269)
- "Most hepatoblastomas are a mixture of fetal and embryonal histologies." — Max Langham (clinical) [Ep 3 · 22:34](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1354)
- "The most common adverse finding is small cell undifferentiated (SCU) histology, which is a primitive tumor with small blue cell morphology and high nuclear-cytoplasmic ratio, making it a much higher risk lesion." — Max Langham (clinical) [Ep 3 · 22:54](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1374)
- "In AHEP 0731, patients with mixed fetal and embryonal histology after upfront resection with negative margins were treated with two courses of cisplatin-based chemotherapy with excellent results." — Max Langham (clinical) [Ep 3 · 24:25](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1465)
- "If the diagnosis is hepatoblastoma, the child needs long-term central access and will have two rounds of cisplatin-based chemotherapy in the United States, then be reimaged." — Max Langham (clinical) [Ep 3 · 25:40](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1540)
- "Most of the tumor shrinkage that will occur with chemotherapy happens in the first two rounds." — Max Langham (clinical) [Ep 3 · 26:31](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1591)
- "After two rounds of chemotherapy and reimaging, the surgeon should make a commitment about resectability; if resectable, do 2 more rounds of chemotherapy, resect after 4, then give 2 consolidation rounds for a total of 6." — Max Langham (clinical) [Ep 3 · 26:41](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1601)
- "Multifocal tumors should be referred to transplantation because they have high recurrence risk after resection." — Max Langham (clinical) [Ep 3 · 27:14](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1634)
- "Most surgeons will be able to make the call about resectability at the end of two rounds of chemotherapy." — Max Langham (opinion) [Ep 3 · 27:59](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1679)
- "A child that is 6 years of age or older with hepatoblastoma is going to be a significantly higher risk patient." — Max Langham (clinical) [Ep 3 · 29:06](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1746)
- "Children who are 8 years of age or older with hepatoblastoma are going to be high risk." — Max Langham (clinical) [Ep 3 · 29:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1793)
- "Children with hepatoblastoma who have normal or near-normal alpha-fetoproteins (less than 100) are going to be high-risk patients." — Max Langham (clinical) [Ep 3 · 30:08](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1808)
- "Pulmonary metastases in hepatoblastoma can have superb results, and current AHEP results look similar to Wilms tumor outcomes with pulmonary mets." — Max Langham (clinical) [Ep 3 · 31:01](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1861)
- "Rapid responders whose pulmonary mets disappear with chemotherapy probably do not need any specific pulmonary therapy." — Max Langham (clinical) [Ep 3 · 31:35](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1895)
- "A child where the pulmonary mets get smaller but persist will need a pulmonary metastectomy, which can be done thoracoscopically or open." — Max Langham (clinical) [Ep 3 · 31:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1913)
- "The Japanese have published using indocyanine green as a marker for thoracoscopic metastectomy because it is concentrated in the liver and lights up." — Max Langham (clinical) [Ep 3 · 32:17](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1937)
- "If pulmonary mets don't disappear, they should be biopsied to confirm metastatic disease and rule out other lesions like histoplasmosis in the Mississippi Valley." — Max Langham (clinical) [Ep 3 · 32:35](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=1955)
- "Before doing anything of consequence with the liver, ensure you can vascularly isolate it by dissecting the suprahepatic and infrahepatic vena cava and placing umbilical tapes for potential clamping." — Max Langham (clinical) [Ep 3 · 36:56](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2216)
- "Disasters during liver resection happen because of major bleeding or air embolism from holes in the low-pressure vena cava system." — Max Langham (clinical) [Ep 3 · 37:52](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2272)
- "Use hypovolemic anesthesia with low CVP during liver resection, preserving transfusions until later in the case, because high CVP causes the liver to swell, become turgid, bleed more, and makes veins harder to dissect." — Max Langham (clinical) [Ep 3 · 38:52](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2332)
- "Take inflow before outflow during liver resection to prevent the liver from swelling." — Max Langham (clinical) [Ep 3 · 39:37](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2377)
- "Anatomic resections are preferred; non-anatomic resections are generally not favored except for lesions hanging off the edge of segments 3 or 5." — Max Langham (opinion) [Ep 3 · 39:46](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2386)
- "The handheld harmonic device used for thyroidectomies is fast with excellent hemostasis for parenchymal transection." — Max Langham (opinion) [Ep 3 · 40:08](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2408)
- "The CUSA is good for dissecting around veins and clearing anatomy but provides no hemostasis." — Max Langham (clinical) [Ep 3 · 40:16](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2416)
- "Staplers work well in older kids and adults but in babies the stapler width can be wider than the margin, potentially causing false positive margins or getting into vessels." — Max Langham (clinical) [Ep 3 · 41:06](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2466)
- "Liver transplant has great 3- and 5-year disease-free survival but requires lifelong immunosuppression with risks of rejection, secondary malignancies, and post-transplant lymphoproliferative disorders." — Max Langham (clinical) [Ep 3 · 42:20](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2540)
- "Extreme resections with vena cava reconstruction or hepatic vein reimplantation can provide equivalent oncologic results to transplant without immunosuppression." — Max Langham (opinion) [Ep 3 · 42:44](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2564)
- "Several patients have developed portal hypertension or other problems late after extreme resections that required transplant or other therapy." — Max Langham (clinical) [Ep 3 · 43:18](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2598)
- "The complication rate of extreme resections is higher than transplantation." — Max Langham (clinical) [Ep 3 · 43:30](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2610)
- "Having a grossly positive margin or leaving gross residual disease behind is not acceptable and should not happen if surgical guidelines are followed." — Max Langham (clinical) [Ep 3 · 44:47](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2687)
- "Gross residual disease most often happens in older kids with trauma who rupture a liver tumor, such as during peewee football." — Max Langham (clinical) [Ep 3 · 45:00](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2700)
- "Kids relapse either locally in the liver or in the lungs." — Max Langham (clinical) [Ep 3 · 45:30](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2730)
- "If a patient has a negative margin resection and relapses locally in the liver, refer them for transplantation; salvage transplantation is not optimal but probably better than re-resection." — Max Langham (opinion) [Ep 3 · 45:36](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2736)
- "For pulmonary recurrence, treating with chemotherapy is important but you will probably need to re-excise the pulmonary mets." — Max Langham (clinical) [Ep 3 · 46:08](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2768)
- "Hepatoblastoma is not thought to be radiation sensitive, and there is almost no anecdotal data of radiation being used in the lungs." — Max Langham (clinical) [Ep 3 · 46:19](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2779)
- "After resection following 4 rounds of chemotherapy with clear margins and no residual tumor, patients usually receive 2 courses of consolidation chemotherapy." — Max Langham (clinical) [Ep 3 · 46:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2813)
- "Most recurrences will happen within the first 3 years of therapy." — Max Langham (clinical) [Ep 3 · 47:02](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2822)
- "After a child gets two cycles of chemotherapy and is restaged, whether it is PRETEXT 2, 3, or has annotation factors, the surgeon's job is to resect that patient after 4 courses of chemotherapy." — Max Langham (clinical) [Ep 3 · 48:02](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2882)
- "In a recent SIOPEL study, nearly half of PRETEXT 4 lesions were resected with conventional resections and did not need liver transplants." — Max Langham (clinical) [Ep 3 · 48:30](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2910)
- "In the US for PRETEXT 4 in AHEP 0731, about 90% of those patients were transplanted." — Max Langham (epidemiological) [Ep 3 · 48:44](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2924)
- "A patient being PRETEXT 3 or 4 does not mean they cannot be resected ultimately; it just means they need chemotherapy first." — Max Langham (clinical) [Ep 3 · 48:53](https://library.globalcastmd.com/watch/hepatoblastoma-291?t=2933)
- "PRETEXT staging stands for pre-treatment extent of disease and is based on segmental liver anatomy, performed prior to chemotherapy." (guideline) [Ep 1 · 2:02](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=122)
- "PRETEXT staging has a tendency to overstage because it is based purely on imaging, and bulky tumors make it difficult to assess true vascular invasion versus mass effect." (clinical) [Ep 1 · 2:28](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=148)
- "POSTTEXT staging refers to extent of disease after neoadjuvant chemotherapy has been given." (guideline) [Ep 1 · 2:51](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=171)
- "Key staging annotations include involvement of the retrohepatic cava or hepatic veins, and the portal vein bifurcation." (guideline) [Ep 1 · 4:10](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=250)
- "COG recommendations state that PRETEXT I-II tumors with clear 1 cm margins and no vascular involvement can be resected locally without referral to specialized centers." (guideline) [Ep 1 · 7:41](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=461)
- "Most tumor volume shrinkage from chemotherapy occurs within the first two cycles." (clinical) [Ep 1 · 10:14](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=614)
- "After 2 cycles of chemotherapy, if the tumor has not shrunk to a resectable size, the patient should be evaluated for transplant." (guideline) [Ep 1 · 10:33](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=633)
- "As hepatoblastoma tumors shrink with chemotherapy, they do not shrink away from vascular supply significantly; size decreases but vascular margins do not substantially improve." (clinical) [Ep 1 · 11:06](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=666)
- "Survival after extensive or 'heroic' resections (tumor liver explants with back table resections and reimplants, portal vein reconstructions, hepatic vein reconstructions) is not as good as transplant survival." (clinical) [Ep 1 · 12:10](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=730)
- "There has been a move away from heroic resections in hepatoblastoma due to inferior survival compared to transplantation." (opinion) [Ep 1 · 12:40](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=760)
- "Patients who undergo rescue transplant after failed resection do far worse than patients who have a planned transplant upfront." (clinical) [Ep 1 · 14:09](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=849)
- "Current thinking is to refer patients to a transplant center early, even if two cycles of chemotherapy will be given first, to have pre-transplant evaluation completed and the patient integrated into the system." (guideline) [Ep 1 · 14:36](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=876)
- "Primary transplant patients do surprisingly well despite immunosuppression for cancer, particularly in liver tumors." (clinical) [Ep 1 · 15:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=911)
- "In the UK, all biliary atresia patients are referred upfront to a transplant center." (clinical) [Ep 1 · 16:02](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=962)
- "For non-transplant center surgeons performing hepatoblastoma resection, there must be 95% confidence of successful resection with adequate margins before proceeding; otherwise referral to a transplant center is indicated." (opinion) [Ep 1 · 17:36](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1056)
- "Anatomic resection with a good margin is appropriate for local management; disease near hepatic veins, crossing the liver, or involving the portal vein should be referred." (opinion) [Ep 1 · 18:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1091)
- "Liver transplant surgeons have extensive experience operating on the liver, which may benefit pediatric surgeons managing borderline-resectable hepatoblastoma cases." (opinion) [Ep 1 · 18:55](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1135)
- "Despite advanced imaging, the truth about resectability is determined at the time of operation." (clinical) [Ep 1 · 19:43](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1183)
- "In Europe, all liver tumors receive chemotherapy upfront before surgery to make the tumor smaller and potentially avoid transplantation." (clinical) [Ep 1 · 19:58](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1198)
- "Trisegmentectomy for cure is a reasonable approach to avoid lifelong immunosuppression from transplantation." (opinion) [Ep 1 · 20:19](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1219)
- "Central hepatectomies have been performed successfully for hepatoblastoma cure without requiring transplant, though it is a difficult operation." (clinical) [Ep 1 · 20:34](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1234)
- "For core needle biopsy of hepatoblastoma, approximately 10 passes are recommended, going through an area that includes normal parenchyma and tumor." (guideline) [Ep 1 · 21:25](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1285)
- "There are two camps regarding pulmonary metastases in hepatoblastoma: one advocates resecting metastases upfront before hepatectomy; the other suggests waiting until after hepatectomy because liver regeneration growth factors may stimulate previously unrecognized lung sites." (clinical) [Ep 1 · 22:11](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1331)
- "There is no good data on either side of the pulmonary metastases timing debate; all evidence is limited to a handful of patients." (clinical) [Ep 1 · 22:45](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1365)
- "Papers examining stage 4 hepatoblastoma with pulmonary metastases are limited to cohorts of less than 20 patients, making it difficult to draw good conclusions." (epidemiological) [Ep 1 · 23:22](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1402)
- "There may be reporting bias in hepatoblastoma transplant literature: successful cases (good chemo response, transplant, long-term survival) are reported, but failures may not be." (opinion) [Ep 1 · 23:38](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1418)
- "PLUTO (Pediatric Liver Unresectable Tumor Observatory) is an international group seeking to answer questions about unresectable hepatoblastoma that cannot be answered at individual or multi-center level within North America or Europe." (clinical) [Ep 1 · 24:02](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1442)
- "It will likely take several years before PLUTO can answer key questions about unresectable hepatoblastoma management." (opinion) [Ep 1 · 24:30](https://library.globalcastmd.com/watch/hepatoblastoma-update-course-2014-648?t=1470)
- "Hepatoblastoma is the most common malignant liver tumor in the pediatric population." (host_summary) [Ep 4 · 0:00](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=0)
- "There are around 250 new cases of hepatoblastoma per year." — Greg Tiao (epidemiological) [Ep 4 · 0:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=15)
- "Neuroblastoma is the most common solid malignancy in the pediatric population." (host_summary) [Ep 4 · 1:13](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=73)
- "The differential diagnosis for a liver mass should include hepatoblastoma, hemangioma, hematomas, focal nodular hyperplasia, and hepatocellular carcinoma." (host_summary) [Ep 4 · 1:28](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=88)
- "Hemangioma is the most common liver lesion in children." — Greg Tiao (epidemiological) [Ep 4 · 1:41](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=101)
- "Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, respiratory distress due to tumor size, or as a paraneoplastic syndrome like precocious puberty." (host_summary) [Ep 4 · 2:08](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=128)
- "An elevated alpha-fetoprotein (AFP) is a key component in the workup of hepatoblastoma and is critical for the diagnostic algorithm and as a guide for treatment response." (host_summary) [Ep 4 · 2:08](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=128)
- "MRI is relied upon by most experts to delineate the anatomy and evaluate the extent of liver involvement in hepatoblastoma." (host_summary) [Ep 4 · 2:39](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=159)
- "EOVIST is an MRI contrast agent that is taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging and distinguishing biliary anatomy." — Greg Tiao (clinical) [Ep 4 · 3:00](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=180)
- "To establish a diagnosis of hepatoblastoma, four things are needed: history, abdominal imaging, AFP check, and liver biopsy." (host_summary) [Ep 4 · 3:17](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=197)
- "The most important intervention for survival in hepatoblastoma is to achieve complete resection." (host_summary) [Ep 4 · 3:17](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=197)
- "Aggressive resections for hepatoblastoma include trisectionectomy, mesohepatectomy, resection with an additional procedure in the remnant liver, and liver transplantation." (host_summary) [Ep 4 · 3:17](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=197)
- "Couinaud labeled the liver segments in a counterclockwise fashion after the districts of Paris, by injecting portal vessels." — Greg Tiao (clinical) [Ep 4 · 4:08](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=248)
- "The right hepatic vein differentiates the anterior sections (segments 5 and 8) from the posterior sections (segments 6 and 7) of the right liver." — Greg Tiao (clinical) [Ep 4 · 4:45](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=285)
- "The right portal vein separates superior segments (7 and 8) from inferior segments (5 and 6) in the right liver." — Greg Tiao (clinical) [Ep 4 · 4:45](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=285)
- "In the PRETEXT staging system, PRETEXT 1 has 3 contiguous sections free of disease, PRETEXT 2 has 2 contiguous sections free, PRETEXT 3 has 1 free section, and PRETEXT 4 has no free sections or diffuse tumor burden in all sections." (host_summary) [Ep 4 · 5:53](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=353)
- "PRETEXT 1 and 2 tumors with greater than a centimeter margin from the middle hepatic vein and the portal bifurcation should be considered for resection at diagnosis." (host_summary) [Ep 4 · 6:34](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=394)
- "The change in practice for PRETEXT 3 and 4 tumors improved survival rates for patients with hepatoblastoma from less than 30% in the 1970s and 1980s to between 80 and 90% today." — Greg Tiao (epidemiological) [Ep 4 · 7:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=435)
- "PRETEXT 3 tumors should generally be biopsied at diagnosis and then started on neoadjuvant chemotherapy, with readiness to send patients to a transplant center or a center with expertise in advanced liver resections depending on response." — Greg Tiao (guideline) [Ep 4 · 7:31](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=451)
- "For PRETEXT 3 or 4 liver disease, specific indications for transplant include unresectable disease, unsafe resection, or resection that would leave the patient with an inadequate liver remnant." — Greg Tiao (guideline) [Ep 4 · 7:31](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=451)
- "It is important to consult a transplant center early for PRETEXT 3 and 4 tumors." (host_summary) [Ep 4 · 8:11](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=491)
- "Teams are now trained to recognize hepatoblastoma tumors and send them to centers that offer transplant or can do aggressive resection, resulting in more patient referrals than 15 years ago." — Greg Tiao (clinical) [Ep 4 · 8:19](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=499)
- "The Pediatric Hepatic International Tumor Trial (FIT) is an ongoing multinational trial aimed at identifying high and low risk features for each of the PRETEXT stages of hepatoblastoma." (host_summary) [Ep 4 · 8:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=526)
- "The FIT study has been ongoing for three years." — Greg Tiao (clinical) [Ep 4 · 9:06](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-4960?t=546)

## Changelog
- Sep 7: 7 items added automatically
- Sep 7: Audit reverted — short clips unhidden
- Sep 7: 6 items added automatically

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