Surgery for hepatoblastoma: from laparoscopic resection to liver transplantation.

Background/aims: Introduction of liver transplantation and the application of minimally invasive surgery for selected hepatoblastoma patients made a tailored surgical approach possible according to the tumor status.

Methodology: We retrospectively evaluated clinical outcomes of 38 pediatric patients with pathologically proven hepatoblastoma who underwent surgery at our institute between 1991 and 2009. Especially, we evaluated recent changes in clinical outcomes since the commencement of liver transplantations and laparoscopic resections for hepatoblastoma patients from 2007.

Results: Complete hepatic tumor resections including 5 liver transplantations were performed in all patients, with 5-year overall survival and event free survival rates of 74.8% and 73.8%, respectively. From 2007, we performed 5 liver transplantations for unresectable cases. No tumor recurrences occurred in any case after a 19.9 (14.5-35.6) months median follow-up period. Totally laparoscopic partial hepatectomies were performed (2 cases) for selected patients. Both cases showed early recovery without any complications and were free of disease recurrence after 8.1 and 19.3 months follow-up period.

Conclusions: Though long term follow-up data is necessary for validation, we suggest that an individualized surgical strategy based on the accurate evaluation of the tumor extent might improve the clinical outcomes of patients with hepatoblastoma.