Evaluating the impact of pulmonary metastasectomy prior to liver transplantation in pediatric hepatoblastoma patients.

PURPOSE: Liver transplantation (LT) has improved the outcomes of patients with unresectable hepatoblastoma; however, pulmonary metastases remain a major prognostic challenge. Therefore, we retrospectively evaluated the impact of pulmonary metastasectomy (PM) performed before LT.

METHODS

Between November 2002 and November 2023, 15 children diagnosed with hepatoblastoma with pulmonary metastases underwent PM. All patients received preoperative chemotherapy. Patients requiring LT underwent PM prior to LT (pre-PM), whereas others underwent PM following hepatectomy (post-PM). Clinical characteristics, alpha-fetoprotein (AFP) levels, PM details, and recurrence rates were compared.

RESULTS

The pre-PM included 8 patients, and the post-PM included 7 patients. The median age at diagnosis was 26 and 40 months, with follow-up periods of 49 and 100 months, respectively. In the pre-PM, 5 patients (63%) required repeated PM after LT, with a median of 3 PMs; all experienced recurrence, and 4 (80%) developed uncontrolled pulmonary metastases. In the post-PM, the median number of PMs was 1; 3 patients (43%) experienced recurrence, but all achieved recurrence-free survival after repeated PM. No significant differences in the baseline characteristics were observed.

CONCLUSION

Whether PM prior to LT is truly beneficial remains to be determined, and further validation through the accumulation of additional cases is required.