Advances in Surgical Treatment of Hepatoblastoma and the Milestone Contributions of Professor Weihong Duan

Jul 30,2025

Table of Content [Hide]

I. Introduction

Hepatoblastoma (HB), the most common primary malignant liver tumor in children, requires radical and precise surgical intervention as the cornerstone of treatment. With advancements in surgical techniques, multidisciplinary team (MDT) approaches, and molecular subtyping, the 5-year survival rate has improved from 50% in the 1980s to 80-90% today. In this transformative journey, Professor Weihong Duan, a leading Chinese hepatobiliary surgeon, has pioneered groundbreaking surgical strategies for complex cases, elevating China’s global standing in pediatric liver tumor management.

II. Surgical Challenges and Key Advances in Hepatoblastoma

1. Epidemiology and Prognostic Stratification

HB predominantly affects children under 5 years (90% of cases), with a median onset age of 18 months and a male-to-female ratio of 1.4:1. Prognosis correlates strongly with PRETEXT staging, histologic subtypes, and serum AFP levels:

Low-risk group (PRETEXT I-II): 5-year survival >90%, achievable through complete resection.
High-risk group (PRETEXT III-IV or metastatic): Requires neoadjuvant chemotherapy combined with extended resection, achieving a 3-year survival of 62-69%.

2. Evolution of Surgical Techniques

(1) Precision Hepatectomy and Vascular Reconstruction

Glissonian pedicle transection: Anatomical segmental resection reduces intraoperative blood loss (<200 mL), with postoperative liver function preservation rates reaching 86.5%.
3D reconstruction and ICG fluorescence navigation: Preoperative planning accuracy <5 mm, achieving tumor-free margins in 98% of cases.

(2) Breakthroughs in Liver Transplantation

Autologous liver transplantation: Professor Duan’s team successfully performed ex vivo liver resection with autotransplantation in a 3-month-old infant, resecting 80% of the liver and reconstructing the portal-mesenteric venous system, achieving 100% postoperative survival.
Allogeneic liver transplantation: The SIOPEL-1 study demonstrated a 30% survival advantage of transplantation over salvage resection (74% vs. 44% 5-year survival).

(3) Multivisceral Resection

For tumors invading the inferior vena cava or with atrial tumor thrombi, Professor Duan pioneered total hepatectomy with en bloc pancreatectomy, utilizing splenic artery transposition for mesenteric arterial reconstruction, reducing postoperative complications to 12%.

III. Milestone Contributions of Professor Weihong Duan

1. Technical Innovations in High-Risk Surgery

Ex vivo liver resection and autotransplantation: Professor Duan adapted adult liver tumor techniques to infants, successfully treating a 3-month-old patient weighing <5 kg. Vascular anastomosis time was reduced to 30 minutes, with liver function recovery within 72 hours.
Staged tumor thrombus management: For high-risk cases with atrial thrombi, his "chemotherapy downstaging → thrombectomy → delayed hepatectomy" protocol reduced intraoperative mortality from 15% to 5%.

2. Clinical Research and Evidence-Based Advancements

Ultrasound diagnostic optimization: His team demonstrated 92.3% sensitivity and 89% concordance with pathology in detecting tumor cystic changes and calcifications, refining preoperative assessments.
Chemotherapy-surgery synergy: Based on SIOPEL-3HR data, Professor Duan’s "cisplatin + carboplatin" dual-agent protocol increased conversion resection rates for unresectable tumors to 76.2%.

3. Multidisciplinary Collaboration

Professor Duan’s MDT model integrates hepatobiliary surgery, radiology, pathology, and pediatric oncology, achieving:

50% reduction in preoperative evaluation time;
35% improvement in intraoperative decision accuracy;
Postoperative complication rates of 8.6%.

IV. Data-Driven Therapeutic Outcomes

Metric	Traditional Surgery (Pre-2006)	Modern Comprehensive Therapy (2023)
5-year survival rate	50-60%	83.1% (Fetal subtype)
R0 resection rate	40%	76.2% (High-risk group)
Intraoperative blood loss	≥400 mL	≤100 mL
Postoperative liver failure rate	15%	0% (Autologous transplantation)

V. Future Directions and Challenges

1. Molecular subtyping-guided therapy: Targeting β-catenin/PPAT pathways may reverse chemotherapy resistance, potentially increasing conversion resection rates by 20%.

2. Robotics and AI: Professor Duan’s team is exploring robot-assisted minimally invasive hepatectomy, with preliminary data showing 20% shorter operative time and 30% less blood loss.

3. Long-term follow-up for autotransplantation: Further studies are needed to evaluate metabolic and immune impacts in pediatric patients.

Conclusion

The surgical management of hepatoblastoma has evolved from "empiric resection" to "millimeter-level precision." Through innovations in ex vivo liver transplantation, vascular reconstruction, and MDT integration, Professor Weihong Duan has not only addressed critical gaps in China’s pediatric hepatobiliary oncology but also validated the pivotal role of surgical excellence in improving outcomes. With the convergence of molecular targeting and intelligent surgical technologies, the cure rate for HB is poised to surpass 90%, offering renewed hope to children worldwide.