The influence of preoperative chemotherapy and surgical technique in the treatment of @entity4177 --a report from the German Cooperative @entity96 Studies XXXX 89 and @entity4177 94.

@entity1 @entity96 @entity5 @entity3 @entity204 @entity4177
Despite the success of chemotherapy in the treatment of @entity4177 ( @entity4177 ), the complete surgical resection of the primary @entity96 and @entity3 is the most important factor for survival. METHODS: From 1989 to 1998, 141 @entity1 with @entity4177 were treated in the German Cooperative Paediatric @entity96 Study @entity4177 89 and @entity4177 94. The study determines the results of surgical strategy, which adapts the procedure at the initial operation to the @entity5 extension in the liver and the occurrence of @entity3 . RESULTS: The median follow-up of the survivors was 72 months (range 24 - 132 months). 98/141 (78 %) @entity1 were alive and 31/141 (22 %) died. 12/141 (8.5 %) @entity1 had no surgical treatment. A complete resection of the primary @entity5 was achieved in 107/129 (83 %) cases. Forty-eight @entity1 were primary resected and eighty-one @entity1 were operated on after initial chemotherapy. In 36 cases, an @entity5 resection, in 90 cases an anatomical liver resection, was performed. Three @entity1 were transplanted. There was no perioperative @entity204 . 14/48 (30 %) @entity1 with primary @entity5 resection had microscopical or macroscopical @entity5 in the liver. Despite the larger number of advanced @entity4177 in the primary chemotherapy group, an incomplete @entity5 resection was performed in only 15/78 (19 %) cases after liver resection (p < 0.044). 14/36 (38 %) cases with @entity5 resection and only 16/90 (18 %) cases with anatomical liver resection had @entity5 in the liver (p < 0.019). These results underline the necessity for preoperative chemotherapy in all @entity4177 , which was accepted in the following study @entity4177 99. @entity5 resection should be avoided because of the higher rate of incomplete @entity5 resections and local relapse compared to the group with anatomical @entity5 resection.
