Experience of surgical treatment for hepatoblastoma

Although the surgery for hepatoblastoma (HB) is the mainstay of treatment, the surgical strategies for HB still need elucidation. This study evaluates the surgical results of HB in our institution since 1996, and we discuss surgical strategies targeting HB. Retrospective chart review. We enrolled 14 patients, of whom 12 and two were newly diagnosed and tumor recurrence patients, respectively. Among the 12 newly diagnosed patients, hepatectomy was performed before and after chemotherapy in four and eight patients, respectively. Tumor resectability was strongly dependent on the surgeon's experience in three cases, achieving long-term tumor-free survival in these patients. One of eight patients with a definite resectable tumor had recurrent HB and received live donor liver transplantation (LDLT) immediately after recurrence, subsequently achieving long-term tumor-free survival. One patient with a definite resectable tumor died because of a congenital heart anomaly. Long-term tumor-free survival was achieved in 91.7% of the newly diagnosed patients. For the two patients referred for recurrence, LDLT was performed on one patient with recurrent HB, although recurrence was observed 4 months after the transplant, and the patient died because of cachexia 1 year after receiving LDLT. A liver autotransplant was performed on the other referred patient with HB recurrence, which failed because of abdominal compartment syndrome. A careful complete resection of HB combined with aggressive chemotherapy can yield long-term survival in most patients with HB. Liver transplantation should be performed in patients with unresectable tumors and tumor recurrence immediately after recurrence. Repeat hepatectomy is not recommended if a live donor is available.