, Bien sûr, une résection chirurgicale complète avec des marges de résection millimétrique reste la règle, nécrose des cellules tumorales résiduelles

, La dissémination des HB se fait préférentiellement de façon hématogène ; ce qui explique la survenue des métastases pulmonaires lors de l'extension de la maladie

, L'envahissement du tronc porte et/ou des 2 branches portales droit et gauche et l'envahissement de la veine cave inférieure et/ou des 3 veines hépatiques sont connus pour être un facteur de mauvais pronostic

, Nous avons évalué l'impact d'un envahissement vasculaire tumoral retrouvé sur l'analyse histologique de la pièce opératoire (donc après chimiothérapie) sur la survie

, Chez les patients de haut risque, un envahissement vasculaire tumoral était de mauvais pronostic et augmentait le risque de récidive. L'étude de Shi et al. 52 montre également que les patients ayant un envahissement vasculaire sur l'analyse histologique avait une survie globale diminuée par rapport aux patients sans envahissement vasculaire Il serait intéressant d, Parmi les patients de risque standard, l'envahissement vasculaire histologique n'avait pas d'impact sur le risque de récidive tumorale

, En 2016 est paru la première étude du CHIC 53 (Children's Hepatic tumors International Collaboration) qui regroupe les 4 sociétés savantes qui ont travaillé sur l'HB (SIOPEL (Société Internationale d'Oncologie Pédiatrique Epithelial Liver Tumor, groupe européen), COG (Children's Oncolgy Group, groupe Nord Américain), GPOH (German Society for Paediatric Oncology and Hematology) et le JPLT (Japanese Study Group for Paediatric Liver Tumours)), Comme nous avons pu le voir dans notre étude, certains résultats n'étaient pas statistiquement significatifs probablement du fait d'un trop petit nombre de patients car l'HB est une maladie rare

, Notre étude ne permet que des conclusions limitées du fait de son aspect unicentrique et rétrospectif. Toutefois, le fait d'avoir travailler sur les données d'un seul BIBLIOGRAPHIE

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