Liver tumors are very rare in children. In addition to malignant hepatoblastoma and hepatocellular carcinoma, there are also some benign tumors, such as cavernous hemangiomas, mesenchymal hamartomas or focal nodular hyperplasia.

In Germany, all malignant diseases that occur in childhood are treated according to binding protocols. This also applies to liver tumors. The corresponding protocols are published and continuously revised by the Society for Pediatric Oncology and Hematology (GPOH)(www.kinderkrebstudien.de). They are then implemented in practice by the pediatric oncologists at MHH, with whom we care for these children on an interdisciplinary basis in very close cooperation.

Hepatoblastomas are the typical liver tumors of small children and can already occur in infants. Treatment is based on one of the above-mentioned treatment protocols, which involve a combination of chemotherapy and surgical removal of the tumor. The chances of a complete cure for hepatoblastoma are quite good at around 75%, but depend on the stage of the tumor.

Hepatocellular carcinoma responds less well to chemotherapy, meaning that surgery is more important in this case. The individual risk is highly variable and depends on numerous factors such as the extent of the tumor. In special cases where no tumor regression (remission) can be achieved despite excessive and protocol-compliant treatment, the possibility of a liver transplant must also be examined.

The treatment of benign liver tumors is usually very cautious. However, it is important to make a correct diagnosis, which can often only be made from the tumor material itself. This therefore requires a tissue sample to be taken. A wait-and-see attitude is only justified once the result and thus the diagnosis have been established beyond doubt. Patients then remain under the continuous observation of a pediatric oncology center for a longer period of time.

The treatment of liver tumors has a long tradition at the MHH. The first study protocols for the treatment of liver tumors were developed here. Since then, our patients have been cared for by an interdisciplinary team. And pediatric surgery at the MHH is still one of the three surgical reference centers for pediatric liver surgery in Germany. From initial diagnostics to chemotherapy and resection of even critically large liver tumors, we offer a one-stop treatment package that naturally also includes liver transplantation as the last remaining option.

As with other childhood tumors, the Department of Pediatric Surgery is part of the interdisciplinary treatment team. As with all other oncological diseases, we also strictly follow the guidelines of the relevant study protocols for liver tumors. Where possible, we obtain the necessary tissue samples using minimally invasive procedures. We also implant the catheter systems required for chemotherapy in accordance with the treatment protocols. We have always carried out extensive tumor resections and complex atypical procedures in close cooperation with the transplant surgeons. In this way, every patient receives the best possible surgical expertise.

Follow-up care is also carried out in accordance with the study protocols and is primarily carried out by the pediatric oncology department.