2024 Volume 61 Issue 3 Pages 223-228
Lung metastasis is a critical factor that influences hepatoblastoma prognosis. Herein, an aggressive metastasectomy was performed for 22 patients, and when the primary tumor could be treated with conventional liver resection, there was no need to change the surgical method due to the presence of lung metastases. However, for some patients, liver transplantation must be considered for complete resection of the primary tumor. We encountered eight patients with lung metastases who received liver transplants, five of whom succumbed to the disease. The causes of death included uncontrolled pulmonary and extrapulmonary metastases. Although simple comparison was not possible, 14 of 18 patients with lung metastases who underwent liver resection but not transplantation and attained positive outcomes. Controlling metastasis and recurrence in the transplant cohort was difficult. Although there have been several reports on the outcomes of liver transplantation in patients with lung metastases, no treatment conclusions have been reached. Therefore, our policy is to perform extreme hepatectomy to avoid liver transplantation, if safety can be ensured. For instance, for a right lobe tumor with a tumor thrombus in the main trunk of the portal vein, right lobectomy should be performed using a meso-Rex shunt, and if the tumor is in contact with the residual hepatic vein, ICG fluorescence should be used to remove the tumor from the vein wall.
