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Article analysis:

This article provides a retrospective study investigating the need for preoperative chemotherapy in pediatric PRETEXT III and IV hepatoblastoma (HB). The authors provide a detailed analysis of the clinical data from 37 children who underwent surgical resection for PRETEXT III and IV HB at their hospital, comparing patients who received neoadjuvant chemotherapy with those who did not. The results showed that upfront surgical resection was safe and feasible, with similar estimated 3-year event-free survival rates between the two groups. Furthermore, the group that underwent routine surgery had fewer courses of chemotherapy than those who received neoadjuvant chemotherapy, as well as lower incidences of febrile neutropenia, gastrointestinal reactions, and other side effects.

The article is generally reliable in its reporting; however, there are some potential biases to consider. Firstly, this is a retrospective study which may be subject to selection bias due to its reliance on existing data rather than randomized controlled trials or prospective studies. Additionally, it is unclear whether all relevant factors were taken into account when making decisions about treatment regimens; for example, it is possible that some patients may have been excluded from receiving preoperative chemotherapy due to underlying medical conditions or other factors which were not reported in this study. Furthermore, while the authors note that the degree of vascular involvement is an important factor in determining resectability during diagnosis, they do not discuss any potential risks associated with performing surgery without preoperative chemotherapy in these cases. Finally, while this study does provide evidence that upfront surgical resection can be a viable option for some patients with PRETEXT III and IV HB, further research should be conducted to determine if this approach can be safely applied more broadly across different patient populations.