2024 Volume 61 Issue 2 Pages 144-147
In April 2008, liver transplantation (LT) for hepatoblastoma became covered under the Japanese medical insurance. Unresectable hepatoblastoma is considered an indication for LT; however, identifying “unresectable” hepatoblastoma is often difficult. Generally, unresectable tumors are those in cases categorized into post-treatment extent of disease grouping system POST-TEXT IV or III P+, V+. However, there are cases in which it is difficult to determine the resectability by preoperative imaging; although the tumor is considered resectable, a final surgical decision should be made at a facility capable of LT. Previously, it was safe to prioritize LT in cases of doubtful resectability owing to reports of extremely poor post-transplantation outcomes in salvage LT for reasons, such as recurrence after hepatectomy. Recently, there have been reports, including those from Japan, that the outcomes of salvage LT are good, and if the risk of long-term complications after LT is considered, challenging liver resection is reevaluated in this LT era. This article outlines the potential of atypical extreme hepatectomy using techniques used in transplant surgery, such as vascular reconstruction and organ preservation, and the surgical approach in cases with insufficient residual liver volume.
