Live Event Content
Hepatocellular Carcinoma
Everything in the library about hepatocellular carcinoma — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
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Update Course 2023 - Updates in the use of ICG
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This session is on updates in the use of ICG with Dr. Seth Goldstein.
The 11th Annual Pediatric Surgery Update Course was held on August 29, 2023 in Cleveland, Ohio and was livestreamed to a global audience. The full day symposium is
video19:57 · Oct 2023
Case-Based Learning
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Clinical & Research Update: Pediatric Liver Tumors - A Case-Based Discussion with Drs. Katherine Somers & Alex Bondoc
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This live event offered a focused, case-based conversation exploring current approaches to pediatric liver tumors across four critical domains:• Liver transplantation — indications, timing, and outcomes• Relapse management — surveillance an
video69:23 · Apr 2026
In-Depth Reviews
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Hepatoblastoma: Update Course 2014
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Dr. Matthew Clifton gives a presentation on hepatoblastoma including discussion of pre-treatment extent of disease (pretext) and post-treatment extent of disease staging for hepatoblastoma, management and surgical resection based on stages,
video24:43 · Nov 2018
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Hepatoblastoma: Update Course 2014
PRETEXT staging stands for pre-treatment extent of disease and is based on segmental liver anatomy, performed prior to chemotherapy.
guideline2:02 ↗
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.
clinical2:28 ↗
POSTTEXT staging refers to extent of disease after neoadjuvant chemotherapy has been given.
guideline2:51 ↗
Key staging annotations include involvement of the retrohepatic cava or hepatic veins, and the portal vein bifurcation.
guideline4:10 ↗
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.
guideline7:41 ↗
Most tumor volume shrinkage from chemotherapy occurs within the first two cycles.
clinical10:14 ↗
After 2 cycles of chemotherapy, if the tumor has not shrunk to a resectable size, the patient should be evaluated for transplant.
guideline10:33 ↗
As hepatoblastoma tumors shrink with chemotherapy, they do not shrink away from vascular supply significantly; size decreases but vascular margins do not substantially improve.
clinical11:06 ↗
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.
clinical12:10 ↗
There has been a move away from heroic resections in hepatoblastoma due to inferior survival compared to transplantation.
opinion12:40 ↗
Patients who undergo rescue transplant after failed resection do far worse than patients who have a planned transplant upfront.
clinical14:09 ↗
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.
guideline14:36 ↗
Primary transplant patients do surprisingly well despite immunosuppression for cancer, particularly in liver tumors.
clinical15:11 ↗
In the UK, all biliary atresia patients are referred upfront to a transplant center.
clinical16:02 ↗
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.
opinion17:36 ↗
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.
opinion18:11 ↗
Liver transplant surgeons have extensive experience operating on the liver, which may benefit pediatric surgeons managing borderline-resectable hepatoblastoma cases.
opinion18:55 ↗
Despite advanced imaging, the truth about resectability is determined at the time of operation.
clinical19:43 ↗
In Europe, all liver tumors receive chemotherapy upfront before surgery to make the tumor smaller and potentially avoid transplantation.
clinical19:58 ↗
Trisegmentectomy for cure is a reasonable approach to avoid lifelong immunosuppression from transplantation.
opinion20:19 ↗
Central hepatectomies have been performed successfully for hepatoblastoma cure without requiring transplant, though it is a difficult operation.
clinical20:34 ↗
For core needle biopsy of hepatoblastoma, approximately 10 passes are recommended, going through an area that includes normal parenchyma and tumor.
guideline21:25 ↗
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.
clinical22:11 ↗
There is no good data on either side of the pulmonary metastases timing debate; all evidence is limited to a handful of patients.
clinical22:45 ↗
Papers examining stage 4 hepatoblastoma with pulmonary metastases are limited to cohorts of less than 20 patients, making it difficult to draw good conclusions.
epidemiological23:22 ↗
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.
opinion23:38 ↗
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.
clinical24:02 ↗
It will likely take several years before PLUTO can answer key questions about unresectable hepatoblastoma management.
opinion24:30 ↗
Clinical & Research Update: Pediatric Liver Tumors - A Case-Based Discussion with Drs. Katherine Somers & Alex Bondoc
Rib fractures or vertebral fractures are fairly common as a presentation factor with hepatic tumors in young children, particularly hepatoblastoma.
clinicalKatherine Somers14:51 ↗
Fractures in hepatoblastoma patients will heal as they go through their therapy, and kids tend to be rather unbothered by their fractures once cancer therapy is underway.
clinicalKatherine Somers15:29 ↗
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