MSK Kids surgeons in New York City are known around the world as experts in complex pediatric liver surgery. We help children whose liver tumors may be in areas that are too hard for other surgeons to remove. Our pediatric liver cancer care team members are experts in these advanced surgeries.

The types of pediatric liver tumors MSK treats

We do liver surgery in kids with all types of liver tumors, including:

• Hepatoblastoma (HEH-puh-toh-bla-STOH-muh)
• Undifferentiated embryonal (uhn-dih-fer-EN-shee-ey-tid em-bree-ON-al) sarcoma (UESL)
• Fibrolamellar hepatocellular (fahy-broh-luh-MEL-er hep-uh-toh-SEL-yuh-ler) carcinoma (FLHCC)

Why surgery is common for liver cancer: The power of liver regeneration

The liver is an organ that regenerates, which means it can grow back. Our surgeons can often take out up to 75% of unhealthy liver tissue in children with advanced liver tumors. The liver then grows back to its original size within 2 months.

Types of surgery for liver tumors in children

The kind of liver cancer surgery your child has depends on the tumor type and how much it has grown or spread.

Surgery for small liver tumors

Some children with small liver tumors only need surgery. This is often true when the tumor is only in the liver and has not spread. Your surgeon will let you know if this is an option for your child.

Surgery along with chemotherapy for large liver tumors

Most children with large liver tumors get up to 4 sessions of chemotherapy before surgery to shrink the tumor. After the first 2 rounds of chemotherapy, your child’s doctors will see if the tumor has shrunk. You will learn then if surgery to remove it may work, or if your child may need a liver transplant.

After surgery, if your child was having chemotherapy, they will get the final 2 cycles.

Pediatric liver transplant in New York City

If liver tumor treatment does not work well, we may decide your child needs a liver transplant. We coordinate pediatric liver transplants with NewYork-Presbyterian Morgan Stanley Children’s Hospital at Columbia University Irving Medical Center.

If parents are a match, you may be able to donate a part of your liver tissue to your child. The transplant team at NewYork-Presbyterian Morgan Stanley Children’s Hospital will let you know if this is possible.

If not, your child may need a transplant from another liver donor. The donated liver tissue will grow back to form a new liver. Your child must take transplant medicines for life, but they will have a healthy liver that works well.

Taking out tumors on both sides of the liver

Liver surgeons at MSK Kids are experts in extreme hepatic resection, an advanced method for liver surgery. This surgery removes tumors that have grown over both the right and left sides of the liver.

These tumors can be very hard to operate on, because they’re near blood vessels and bile ducts. MSK surgeons are experts at working around these issues. They can take out the cancer but leave enough healthy liver to grow back.

Many surgeons elsewhere do not have the experience to do this surgery. Instead, they prefer to refer a child for a liver transplant.

Follow-up care for kids after liver tumor surgery at MSK

Checking alpha-fetoprotein (AFP) levels

After surgery, we will check your child’s blood for a protein called alpha-fetoprotein (AL-fuh-FEE-toh-PROH-teen). The AFP level rises when there are liver tumors and should fall after treatment.

If it rises, we will do more tests to see if the tumor has come back. If so, we will choose the best treatment for your child.

Long-term follow-up

MSK Kids has one of the oldest programs for childhood cancer survivors in the country. We encourage children to get follow-up care through the program within 2 years of their treatment for liver tumors.